Lakeshore Spine and Pain P C

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

LAKESHORE SPINE AND PAIN P C

Practice address

5511 W US Highway 10
Ludington, MI 49431-2455

Phone

(231) 843-1553

Fax

(231) 845-7056

NPI assigned

Jul 4, 2006

Organization subpart

No

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

Authorized official

Name

Raj C Makwana

Title

Administrator

Phone

(231) 843-1553

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lakeshore Family Practice Doing business as

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307059200000",
    "number": "1245260371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5511 W US HIGHWAY 10",
            "city": "LUDINGTON",
            "state": "MI",
            "postal_code": "494312455",
            "telephone_number": "231-843-1553",
            "fax_number": "231-845-5515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5511 W US HIGHWAY 10",
            "city": "LUDINGTON",
            "state": "MI",
            "postal_code": "494312455",
            "telephone_number": "231-843-1553",
            "fax_number": "231-845-7056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE SPINE AND PAIN P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2011-06-03",
        "status": "A",
        "authorized_official_last_name": "MAKWANA",
        "authorized_official_first_name": "RAJ",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "231-843-1553"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "700E310160",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeshore Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Leah Erin Kruk, DNP FNP
• Carol Ann Kubanek-Erdman, R.N.
• Sarah Kucera
• Nathaniel Thomas Ladaga, DO
• Lakeshore Regional Entity
• Lakeshore Spine and Pain PC
• Lakeshore Vein &Laser Clinic PLLC
• Lakewinds Dental Centre
• Britney Laman, LMSW
• Jaime Lynn Lamendola, RN

• Specialist in Ludington, MI
• Providers in Ludington, MI by specialty
• Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2011; 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.