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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
1207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1568232247
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKELAND MEDICAL PRACTICES
Provider Business Mailing Address
First Line : 100 MICHIGAN ST NE # MC845
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9623 RED ARROW HWY
Second Line :
City : BRIDGMAN
State : MI
Zip : 49106
Country : US
Telephone Number : 269-465-6050
Fax Number :
Authorized Official
Title or Position : CFO
Name : MATTHEW E COX
Credential :
Telephone Number : 616-486-6790
Provider Enumeration Date : 01/04/2024
Last Update Date : 01/04/2024

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Directions to “LAKELAND MEDICAL PRACTICES ” Practice Location

Language Start Address Practice Location
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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