Provider Demographics
NPI:1932788346
Name:LAKESHORE KIDNEY CARE, PLLC
Entity Type:Organization
Organization Name:LAKESHORE KIDNEY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANSUR
Authorized Official - Middle Name:KHALID
Authorized Official - Last Name:PATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-366-1361
Mailing Address - Street 1:46671 PINEHURST CIR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-8488
Mailing Address - Country:US
Mailing Address - Phone:734-366-1361
Mailing Address - Fax:
Practice Address - Street 1:4811 VENOY RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2675
Practice Address - Country:US
Practice Address - Phone:734-366-1361
Practice Address - Fax:734-366-1359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-03
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty