Provider Demographics
NPI:1639266794
Name:LAKESHORE EMERGENCY SOLUTIONS, PLLC
Entity Type:Organization
Organization Name:LAKESHORE EMERGENCY SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-751-1157
Mailing Address - Street 1:3114 CROASDAILE DR STE 200
Mailing Address - Street 2:LAKESHORE EMERGENCY SOLUTIONS, PLLC
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2508
Mailing Address - Country:US
Mailing Address - Phone:919-425-1565
Mailing Address - Fax:919-425-0478
Practice Address - Street 1:72 S STATE ST
Practice Address - Street 2:LAKESHORE EMERGENCY SOLUTIONS, PLLC
Practice Address - City:SHELBY
Practice Address - State:MI
Practice Address - Zip Code:49455-1228
Practice Address - Country:US
Practice Address - Phone:231-861-2156
Practice Address - Fax:919-425-0478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P38120Medicare PIN