Provider Demographics
NPI:1699786624
Name:LAKES URGENT CARE, INC.
Entity type:Organization
Organization Name:LAKES URGENT CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:J
Authorized Official - Last Name:VIEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-926-9111
Mailing Address - Street 1:PO BOX 251956
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325-1956
Mailing Address - Country:US
Mailing Address - Phone:248-926-9111
Mailing Address - Fax:248-926-9112
Practice Address - Street 1:2300 HAGGERTY RD
Practice Address - Street 2:SUITE 1010
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2184
Practice Address - Country:US
Practice Address - Phone:248-926-9111
Practice Address - Fax:248-926-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
139387OtherCARE CHOICES
700F327420OtherBCBS OF MICHIGAN
0N92240OtherHEALTH ALLIANCE PLAN
700F327420OtherBCBS OF MICHIGAN