Provider Demographics
NPI:1124346515
Name:LAKELAND MEDICAL PRACTICES
Entity type:Organization
Organization Name:LAKELAND MEDICAL PRACTICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP PHYSICIANS PRACTICES
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:269-983-8304
Mailing Address - Street 1:5675 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-1033
Mailing Address - Country:US
Mailing Address - Phone:269-429-7227
Mailing Address - Fax:269-429-5754
Practice Address - Street 1:5675 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-1033
Practice Address - Country:US
Practice Address - Phone:269-429-7227
Practice Address - Fax:269-429-5754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center