| Organization Name: | LAKESHORE ENT |
| NPI Number: | 1003096991 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEPHEN GEORGE KRZEMINSKI (OWNER) |
| Mailing Address: | 1305 Paluxy Rd Suite A Granbury |
| State: | TX US |
| Postal Code: | 760485641 |
| Phone Number: | 8175736673 |
| Fax Number: | 8175739783 |
| NPI Enumeration Date: | 11/07/2007 |
| NPI Last Update Date: | 01/07/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207YS0123X |
| License Number: | K8272 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Otolaryngology |
| Taxonomy Specialization: | Facial Plastic Surgery |
| Taxonomy Definition: | An otolaryngologist who specializes in facial plastic surgery. |