LAKESHORE INTERNAL MEDICINE AND PEDIATRIC ASSOCIATES NPI 1003924739

NPI Information

NPI: 1003924739
Provider Name: LAKESHORE INTERNAL MEDICINE AND PEDIATRIC ASSOCIATES
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

CLIA Number: 23D0967100

Address:
437 NORTH 120TH AVE
HOLLAND, MI
ZIP 49424
Phone: (616) 738-0737
Get Directions

LAKESHORE INTERNAL MEDICINE AND PEDIATRIC ASSOCIATES is a multi-specialty clinic center in Holland, MI. LAKESHORE INTERNAL MEDICINE AND PEDIATRIC ASSOCIATES NPI is 1003924739. The provider is registered as an organization entity type.

The provider's business location address is:

437 NORTH 120TH AVE
HOLLAND, MI
ZIP 49424
Phone: (616) 738-0737

The provider's authorized official is Barbara Martin .
The authorized official title is Billing and has the following contact phone number (616) 453-6329.

The CLIA number assigned to this NPI record is 23D0967100 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 8/25/2006 and was last updated on 6/7/2016.

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
1	261QM1300X	Clinic/Center	Multi-Specialty	4301074294	MICHIGAN	No
2	261QM1300X	Clinic/Center	Multi-Specialty	4301074445	MICHIGAN	No
3	261QM1300X	Clinic/Center	Multi-Specialty	4301066494	MICHIGAN	Yes

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
1	G96493	MEDICARE UPIN	MICHIGAN
2	4531728	MEDICAID	MICHIGAN
3	4529541	MEDICAID	MICHIGAN
4	H83269	MEDICARE UPIN	MICHIGAN
5	0N14150002	MEDICARE ID-TYPE UNSPECIFIED	MICHIGAN	DR SCHROTENBOER
6	0N14150004	MEDICARE ID-TYPE UNSPECIFIED	MICHIGAN	DR MILLER
7	H64113	MEDICARE UPIN	MICHIGAN
8	4193863	MEDICAID	MICHIGAN

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

NPI Synchronization or Removal

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