Clarkston Lakes Family Medicine LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

JB067853 Issued in MI

Legal business name

CLARKSTON LAKES FAMILY MEDICINE LLC

Practice address

6483 Citation Dr
Suite B
Clarkston, MI 48346-2994

Phone

(248) 922-3074

Fax

(248) 922-3081

NPI assigned

Jul 14, 2005

Organization subpart

No

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

Authorized official

Name

Dr. John A Blanchard, MD

Title

Owner/Physician

Phone

(248) 922-3074

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Salta, PLLC

  • Family Medicine Physician
  • Pontiac, MI
  • NPI 1588112387
  NPPES parent name

Practitioners 3

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

• Monica M Dimagno, MD

  • Internal Medicine Physician
  • Ann Arbor, MI
  • NPI 1063501930
  NPD (past)
• Lawrence J McMaster, DO

  • Internal Medicine Physician
  • Ann Arbor, MI
  • NPI 1316028541
  NPD (past)
• David R Stutz, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Ann Arbor, MI
  • NPI 1558451088
  NPD (past)

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

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329696000000",
    "number": "1457359267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6483 CITATION DR",
            "address_2": "SUITE B",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483462994",
            "telephone_number": "248-922-3074",
            "fax_number": "248-922-3081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6483 CITATION DR",
            "address_2": "SUITE B",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483462994",
            "telephone_number": "248-922-3074",
            "fax_number": "248-922-3081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKSTON LAKES FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-14",
        "last_updated": "2012-02-20",
        "status": "A",
        "authorized_official_last_name": "BLANCHARD",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "248-922-3074",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "JB067853",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN",
            "identifier": "080F320090",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1457359267",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "CK5028",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "080F320090",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clarkston Dermatology & Vein Center PLLC
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• Clarkston Family Therapists LLC
• Clarkston Health Center
• Clarkston Internal Medicine, P.C.
• Clarkston Medical Clinic PC
• Clarkston Oaks Family Dentistry
• Clarkston Opco LLC (Villa at Pine Place)
• Clarkston Operating Company LLC (Clarkston Specialty Healthcare Center)
• Clarkston Pediatric Dentistry PLC

• Family Medicine Physician in Clarkston, MI
• Providers in Clarkston, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2012; 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.