Provider Demographics
NPI:1912258872
Name:LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE
Entity Type:Organization
Organization Name:LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE
Other - Org Name:LECOM SCHOOL OF DENTAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FISCAL AFFAIRS/CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:INMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-868-8258
Mailing Address - Street 1:4800 LAKEWOOD RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-4953
Mailing Address - Country:US
Mailing Address - Phone:941-405-1507
Mailing Address - Fax:941-405-1675
Practice Address - Street 1:4800 LAKEWOOD RANCH BLVD
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-4953
Practice Address - Country:US
Practice Address - Phone:941-405-1507
Practice Address - Fax:941-405-1675
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-01
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty