Provider Demographics
NPI:1619937257
Name:LAKIND, GARY EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:EDWARD
Last Name:LAKIND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 PUTNAM DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-3856
Mailing Address - Country:US
Mailing Address - Phone:248-851-3555
Mailing Address - Fax:
Practice Address - Street 1:5315 PUTNAM DR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-3856
Practice Address - Country:US
Practice Address - Phone:248-851-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015091207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine