Provider Demographics
NPI:1962634378
Name:LAKESHORE HEALTH PARTNERS
Entity type:Organization
Organization Name:LAKESHORE HEALTH PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-394-3515
Mailing Address - Street 1:3235 N WELLNESS DR
Mailing Address - Street 2:SUITE 120B
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-7264
Mailing Address - Country:US
Mailing Address - Phone:616-403-9559
Mailing Address - Fax:616-396-9532
Practice Address - Street 1:3235 N WELLNESS DR
Practice Address - Street 2:SUITE 120B
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-7264
Practice Address - Country:US
Practice Address - Phone:616-403-9559
Practice Address - Fax:616-396-9532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty