Lake, Dennis

Lake, Dennis is an individual health care provider with primary practice located at 710 Kenmoor Ave Se Suite 110, Grand Rapids MI 49546-2379. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Lake, Dennis can be contacted via phone (616) 949-6112.

Contact Information

Primary practice address
710 Kenmoor Ave Se Suite 110 Grand Rapids MI 49546-2379
Phone: (616) 949-6112
Fax: (616) 949-8530
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 4301039973 Michigan

Profile Details

NPI number 1700986205
LBN Legal business name Lake, Dennis
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 24th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700986205 NPPES
Michigan MEDICAID 2890360

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