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NPI Code Detail

MEDICARE: LAKEFOREST AMBULATORY SURGERY CENTER

MEDICARE: LAKEFOREST AMBULATORY SURGERY CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QA1903XAmbulatory Surgical Clinic/CenterA1136MD

General Provider Information

NPI Number : 1326202086
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKEFOREST AMBULATORY SURGERY CENTER
Provider Business Mailing Address
First Line : 702 RUSSELL AVE
Second Line : SUITE 103
City : GAITHERSBURG
State : MD
Zip : 20877-2606
Country : US
Telephone Number : 301-948-3668
Fax Number : 301-926-7787
Provider Business Practice Location Address
First Line : 6400 MARLBORO PIKE
Second Line :
City : DISTRICT HEIGHTS
State : MD
Zip : 20747-2841
Country : US
Telephone Number : 301-736-6900
Fax Number : 301-736-7180
Authorized Official
Title or Position : MEDICAL DIRECTOR AND OWNER
Name : DR. MICHAEL LAWRENCE MICHETTI
Credential : DPM
Telephone Number : 301-948-3668
Provider Enumeration Date : 07/11/2008
Last Update Date : 07/11/2008

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Directions to “LAKEFOREST AMBULATORY SURGERY CENTER ” Practice Location

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