Provider Demographics
NPI:1518626043
Name:LAKE MICHIGAN OBSERVATION SERVICES PLLC
Entity Type:Organization
Organization Name:LAKE MICHIGAN OBSERVATION SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:EMMETT
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-881-2855
Mailing Address - Street 1:800 E ELLIS RD # 571
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5622
Mailing Address - Country:US
Mailing Address - Phone:231-728-4601
Mailing Address - Fax:231-728-5777
Practice Address - Street 1:1500 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1849
Practice Address - Country:US
Practice Address - Phone:231-672-3916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKE MICHIGAN EMERGENCY SPECIALISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-13
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty