Provider Demographics
NPI:1588844237
Name:LAKES SURGICARE CENTER
Entity Type:Organization
Organization Name:LAKES SURGICARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GOVERNANCE
Authorized Official - Prefix:DR
Authorized Official - First Name:G.
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:SHANAHAN
Authorized Official - Suffix:IV
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-360-3888
Mailing Address - Street 1:9640 COMMERCE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4167
Mailing Address - Country:US
Mailing Address - Phone:248-360-3888
Mailing Address - Fax:248-363-0894
Practice Address - Street 1:9640 COMMERCE RD STE 102
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-4167
Practice Address - Country:US
Practice Address - Phone:248-360-3888
Practice Address - Fax:248-363-0894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-10
Last Update Date:2007-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric