Provider Demographics
NPI:1679667687
Name:LAKEVIEW INTERNAL MEDICINE,P.C
Entity Type:Organization
Organization Name:LAKEVIEW INTERNAL MEDICINE,P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THILAK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-635-9090
Mailing Address - Street 1:2118 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1200
Mailing Address - Country:US
Mailing Address - Phone:906-635-9090
Mailing Address - Fax:906-635-9091
Practice Address - Street 1:558 ASHMUN ST
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-4001
Practice Address - Country:US
Practice Address - Phone:906-635-9090
Practice Address - Fax:906-635-9091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068603207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty