Basic Information
| Provider Information | |||||||||
| NPI: | 1487862140 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAMIS,INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15450 NORTHLINE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SOUTHGATE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481952398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342822020 | ||||||||
| FaxNumber: | 7342822002 | ||||||||
| Practice Location | |||||||||
| Address1: | 15450 NORTHLINE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SOUTHGATE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481952398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342822020 | ||||||||
| FaxNumber: | 7342822002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 12/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | KANAAN | ||||||||
| AuthorizedOfficialFirstName: | AMMAR | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 7342822020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301077121 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.