MEDICARE: LAKELAND HOSPITALS AT NILES AND ST JOSEPH, INC

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	207RP1001X	Pulmonary Disease Physician

General Provider Information

NPI Number	:	1720766181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKELAND HOSPITALS AT NILES AND ST JOSEPH, INC

Provider Business Mailing Address
First Line	:	100 MICHIGAN NE ST MC845
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503
Country	:	US
Telephone Number	:	616-486-6790
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 W MAIN ST
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-3606
Country	:	US
Telephone Number	:	269-408-2258
Fax Number	:

Authorized Official
Title or Position	:	VP FINANCE
Name	:	HEATHER LALLO
Credential	:
Telephone Number	:	616-391-2022

Provider Enumeration Date	:	07/06/2023
Last Update Date	:	07/06/2023

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