LAKE MICHIGAN NEPHROLOGY L.L.C NPI 1821201500

NPI Information

  • NPI: 1821201500
  • Provider Name: LAKE MICHIGAN NEPHROLOGY, L.L.C
  • Classification: Specialist - 174400000X
  • Entity Type: Organization
  • CLIA Number: 23D0723416
  • Address: 3800 HOLLYWOOD RD STE 104
    SAINT JOSEPH, MI
    ZIP 49085
  • Phone: (269) 428-0819

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NPI Details

LAKE MICHIGAN NEPHROLOGY, L.L.C is a specialist in Saint Joseph, MI. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. LAKE MICHIGAN NEPHROLOGY, L.L.C NPI is 1821201500. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3800 HOLLYWOOD RD STE 104
SAINT JOSEPH, MI
ZIP 49085-511
Phone: (269) 428-0819
Fax: (269) 428-0841

The provider's authorized official is Daniel William Brash .
The authorized official title is Owner and has the following contact phone number (269) 428-0819.

The CLIA number assigned to this NPI record is 23D0723416 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 5/8/2007 and was last updated on 10/5/2023.

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
1174400000XSpecialist4301079804MICHIGANYes

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: 11/21/2025

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