| Organization Name: | LAKESHORE INTERNAL MEDICINE AND PEDIATRIC ASSOCIATES |
| NPI Number: | 1003924739 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BARBARA MARTIN (BILLING) |
| Mailing Address: | 437 North 120th Ave Holland |
| State: | MI US |
| Postal Code: | 49424 |
| Phone Number: | 6167380737 |
| Fax Number: | |
| NPI Enumeration Date: | 08/25/2006 |
| NPI Last Update Date: | 06/07/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | 4301074294 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |