Basic Information
| Provider Information | |||||||||
| NPI: | 1639266794 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAKESHORE EMERGENCY SOLUTIONS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3114 CROASDAILE DR STE 200 | ||||||||
| Address2: | LAKESHORE EMERGENCY SOLUTIONS, PLLC | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277052508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194251565 | ||||||||
| FaxNumber: | 9194250478 | ||||||||
| Practice Location | |||||||||
| Address1: | 72 S STATE ST | ||||||||
| Address2: | LAKESHORE EMERGENCY SOLUTIONS, PLLC | ||||||||
| City: | SHELBY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494551228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2318612156 | ||||||||
| FaxNumber: | 9194250478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2006 | ||||||||
| LastUpdateDate: | 05/27/2009 | ||||||||
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| AuthorizedOfficialLastName: | SCOTT | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8777511157 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.