MEDICARE: GREGORY LAMBOURNE M.D.

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	4301036909	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1105708412	OTHER		BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598775850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY LAMBOURNE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 384
Second Line	:
City	:	CADILLAC
State	:	MI
Zip	:	49601-0384
Country	:	US
Telephone Number	:	231-775-6076
Fax Number	:	231-775-0027

Provider Business Practice Location Address
First Line	:	1866 S MOREY RD
Second Line	:
City	:	LAKE CITY
State	:	MI
Zip	:	49651-9190
Country	:	US
Telephone Number	:	231-775-4841
Fax Number	:	231-839-7222

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	09/26/2007

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