MEDICARE: LAKES AREA HOSPITALISTS,PC

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
1	207R00000X	Internal Medicine Physician	4301406079	MI

General Provider Information

NPI Number	:	1558558924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKES AREA HOSPITALISTS,PC

Provider Business Mailing Address
First Line	:	6520 CASTLEBURY DR
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-2711
Country	:	US
Telephone Number	:	248-561-3692
Fax Number	:

Provider Business Practice Location Address
First Line	:	6520 CASTLEBURY DR
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-2711
Country	:	US
Telephone Number	:	248-561-3692
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DIANA GUERRERO BETANCOURT
Credential	:	M.D.
Telephone Number	:	248-561-3692

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	04/17/2015

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