Provider Demographics
NPI:1902833163
Name:LAME, MARC E (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:E
Last Name:LAME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14695 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1929
Mailing Address - Country:US
Mailing Address - Phone:231-547-2812
Mailing Address - Fax:231-547-3067
Practice Address - Street 1:14695 PARK AVE
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720
Practice Address - Country:US
Practice Address - Phone:231-547-2812
Practice Address - Fax:231-547-3067
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045907208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1918377Medicaid
MI0150004Medicare ID - Type Unspecified
MI1918377Medicaid