Organization Name: | LAKELAND HOUSECALLS |
NPI Number: | 1699086744 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DENNIS MACK (V P OPERATIONS & FACILITY) |
Mailing Address: | 122 Grant St Niles |
State: | MI US |
Postal Code: | 491202281 |
Phone Number: | 2699854401 |
Fax Number: | 2696840189 |
NPI Enumeration Date: | 06/23/2010 |
NPI Last Update Date: | 06/23/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |