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LAKESHORE UROLOGY PLC NPI 1275872509


NPI Information

NPI: 1275872509
Provider Name: LAKESHORE UROLOGY PLC
Classification: Urology - 208800000X
Entity Type: Organization

CLIA Number: 23D2054988

Address:
1445 SHELDON RD
SUITE 102
GRAND HAVEN, MI
ZIP 49417
Phone: (616) 604-8363
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LAKESHORE UROLOGY PLC is an urology in Grand Haven, MI. The provider is a urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. LAKESHORE UROLOGY PLC NPI is 1275872509. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1445 SHELDON RD
SUITE 102
GRAND HAVEN, MI
ZIP 49417-480
Phone: (616) 604-8363
Fax: (616) 604-8364

The provider's authorized official is Caleb J Fleming .
The authorized official title is Medical Director and has the following contact phone number (616) 604-8363.

The CLIA number assigned to this NPI record is 23D2054988 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 2/6/2013 and was last updated on 2/15/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208800000XUrology4301048869MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1101995044MEDICAIDMICHIGAN
2F01767MEDICARE UPINMICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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