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NPI Code Detail

MEDICARE: LAKELAND MEDICAL PRACTICES

MEDICARE: LAKELAND MEDICAL PRACTICES
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
1207Y00000XOtolaryngology Physician4301074795MI

General Provider Information

NPI Number : 1487947446
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKELAND MEDICAL PRACTICES
Provider Business Mailing Address
First Line : PO BOX 458
Second Line :
City : NILES
State : MI
Zip : 49120-0458
Country : US
Telephone Number : 269-471-9702
Fax Number : 269-471-9707
Provider Business Practice Location Address
First Line : 9045 US HIGHWAY 31
Second Line : STE 3
City : BERRIEN SPRINGS
State : MI
Zip : 49103-1804
Country : US
Telephone Number : 269-471-9702
Fax Number : 269-471-9707
Authorized Official
Title or Position : DIRECTOR, PRACTICE OPERATIONS
Name : JANICE CROCKER
Credential :
Telephone Number : 269-687-1152
Provider Enumeration Date : 05/25/2011
Last Update Date : 05/25/2011

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Directions to “LAKELAND MEDICAL PRACTICES ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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