Provider Demographics
NPI:1285896514
Name:LAKIS, JENNIFER LEE (DO)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:LAKIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:14 MAINE ST # 14
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2049
Mailing Address - Country:US
Mailing Address - Phone:207-798-9677
Mailing Address - Fax:207-406-2029
Practice Address - Street 1:14 MAINE ST # 14
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2049
Practice Address - Country:US
Practice Address - Phone:207-798-9677
Practice Address - Fax:207-406-2029
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2015-04-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME1999204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1285896514Medicare UPIN