Provider Demographics
NPI:1790984391
Name:LAKES URGENT CARE INC
Entity Type:Organization
Organization Name:LAKES URGENT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:VIEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-926-9111
Mailing Address - Street 1:PO BOX 251956
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325-1956
Mailing Address - Country:US
Mailing Address - Phone:800-827-3797
Mailing Address - Fax:248-553-2108
Practice Address - Street 1:2300 HAGGERTY RD
Practice Address - Street 2:SUITE 1010
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2184
Practice Address - Country:US
Practice Address - Phone:248-926-9111
Practice Address - Fax:248-926-9112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKES URGENT CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N92240Medicare PIN