NPIMap

Organization Active NPI

Lakeshore Surgical Associates PC

  • Surgery Physician
  • Holland, MI
National Provider Identifier
1013973585
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
LAKESHORE SURGICAL ASSOCIATES PC
Practice address
577 Michigan Ave
Suite 202
Holland, MI 49423-4911
Phone
(616) 394-0673
Fax
(616) 394-9825
NPI assigned
Apr 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Daniel J Decook, MDNPI 1396702312
Title
President/Physician
Phone
(616) 394-0673

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

577 Michigan Ave
Suite 202
Holland, MI 49423-4911

Mailing address

577 Michigan Ave
Suite 202
Holland, MI 49423-4911
Phone (616) 394-0673

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013973585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "577 MICHIGAN AVE",
            "address_2": "SUITE 202",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494234911",
            "telephone_number": "616-394-0673",
            "fax_number": "616-394-9825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "577 MICHIGAN AVE",
            "address_2": "SUITE 202",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494234911",
            "telephone_number": "616-394-0673",
            "fax_number": "616-394-9825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE SURGICAL ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DECOOK",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT/PHYSICIAN",
        "authorized_official_telephone_number": "616-394-0673",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holland, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.