Provider Demographics
NPI:1982633798
Name:COLDWATER OBSTETRICS & GYNECOLOGY, P.C.
Entity Type:Organization
Organization Name:COLDWATER OBSTETRICS & GYNECOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:517-279-8465
Mailing Address - Street 1:235 E CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-1783
Mailing Address - Country:US
Mailing Address - Phone:517-279-8465
Mailing Address - Fax:517-279-8665
Practice Address - Street 1:235 E CHICAGO ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1783
Practice Address - Country:US
Practice Address - Phone:517-279-8465
Practice Address - Fax:517-279-8665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0A26007Medicare ID - Type UnspecifiedCOMMON PROVIDER NUMBER