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
1	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1679074470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKELAND MEDICAL PRACTICES

Provider Business Mailing Address
First Line	:	2500 NILES RD STE 9
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-3268
Country	:	US
Telephone Number	:	269-408-1115
Fax Number	:	269-408-1166

Provider Business Practice Location Address
First Line	:	2500 NILES RD STE 9
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-3268
Country	:	US
Telephone Number	:	269-408-1115
Fax Number	:	269-408-1166

Authorized Official
Title or Position	:	MEDICAL STAFF COORDINATOR
Name	:	MORGAN VINCENT
Credential	:
Telephone Number	:	269-983-8282

Provider Enumeration Date	:	02/27/2018
Last Update Date	:	02/27/2018

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Directions to “LAKELAND MEDICAL PRACTICES ” Practice Location

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