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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 : 1629352711
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKELAND MEDICAL PRACTICES
Provider Business Mailing Address
First Line : 800 M 139
Second Line :
City : BENTON HARBOR
State : MI
Zip : 49022-3881
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 800 M 139
Second Line : SUITE D
City : BENTON HARBOR
State : MI
Zip : 49022-3881
Country : US
Telephone Number : 269-869-6900
Fax Number : 269-934-9146
Authorized Official
Title or Position : VICE PRESIDENT PHYSICIAN PRACTICES
Name : WARREN WHITE JR.
Credential :
Telephone Number : 269-983-8304
Provider Enumeration Date : 10/06/2011
Last Update Date : 03/14/2016

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Directions to “LAKELAND MEDICAL PRACTICES ” Practice Location

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