Provider Demographics
NPI:1013047323
Name:LAKEVIEW OBSTETRICS & GYNECOLOGY PC
Entity Type:Organization
Organization Name:LAKEVIEW OBSTETRICS & GYNECOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:KLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-732-3550
Mailing Address - Street 1:644 CLARK DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-3714
Mailing Address - Country:US
Mailing Address - Phone:704-732-3550
Mailing Address - Fax:
Practice Address - Street 1:644 CLARK DR
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3714
Practice Address - Country:US
Practice Address - Phone:704-732-3550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902900Medicaid
2331340Medicare ID - Type UnspecifiedGROUP NUMBER