Provider Demographics
NPI:1174918015
Name:LAKELAND MEDICAL PRACTICES
Entity type:Organization
Organization Name:LAKELAND MEDICAL PRACTICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT PHYSICIAN 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:269-983-8624
Mailing Address - Street 1:3904 STONEGATE PARK
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9130
Mailing Address - Country:US
Mailing Address - Phone:269-982-5864
Mailing Address - Fax:269-982-5113
Practice Address - Street 1:3904 STONEGATE PARK
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9130
Practice Address - Country:US
Practice Address - Phone:269-982-5864
Practice Address - Fax:269-982-5113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty