Provider Demographics
NPI:1780745711
Name:LAKEPOINTE INTERNAL MEDICINE, LLC
Entity type:Organization
Organization Name:LAKEPOINTE INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-471-7859
Mailing Address - Street 1:7201 E VIRGINIA ST STE D
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-4072
Mailing Address - Country:US
Mailing Address - Phone:812-471-7859
Mailing Address - Fax:812-471-7912
Practice Address - Street 1:7201 E VIRGINIA ST
Practice Address - Street 2:STE D
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4072
Practice Address - Country:US
Practice Address - Phone:812-471-7859
Practice Address - Fax:812-471-7912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDF6966Medicare PIN
IN249720AMedicare PIN
IN249720Medicare PIN