NPIMap

Organization Active NPI

Lakeland Medical Practices

  • Otolaryngology Physician
  • Berrien Springs, MI
National Provider Identifier
1487947446
Registry record updated May 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
4301074795 Issued in MI
Legal business name
LAKELAND MEDICAL PRACTICES
Practice address
9045 US Highway 31
Ste 3
Berrien Springs, MI 49103-1804
Phone
(269) 471-9702
Fax
(269) 471-9707
NPI assigned
May 25, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2011

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

Authorized official

Name
Janice Crocker
Title
Director, Practice Operations
Phone
(269) 687-1152

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X 4301074795 MI Primary

Addresses

Primary practice location

9045 US Highway 31
Ste 3
Berrien Springs, MI 49103-1804

Mailing address

PO Box 458
Niles, MI 49120-0458
Phone (269) 471-9702

Other names 1

  • Lakeland Ear Nose & Thoart Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lakeland Medical Practices49 organizations share this tax ID, including this one

Other organizations with this tax ID 48

Organizations that report the same tax identification number in the National Provider Directory.

View all 48

Practitioners & affiliated clinicians

Practitioners 2

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": "1306281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306281600000",
    "number": "1487947446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 458",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491200458",
            "telephone_number": "269-471-9702",
            "fax_number": "269-471-9707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9045 US HIGHWAY 31",
            "address_2": "STE 3",
            "city": "BERRIEN SPRINGS",
            "state": "MI",
            "postal_code": "491031804",
            "telephone_number": "269-471-9702",
            "fax_number": "269-471-9707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKELAND MEDICAL PRACTICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-25",
        "last_updated": "2011-05-25",
        "status": "A",
        "authorized_official_last_name": "CROCKER",
        "authorized_official_first_name": "JANICE",
        "authorized_official_title_or_position": "DIRECTOR, PRACTICE OPERATIONS",
        "authorized_official_telephone_number": "269-687-1152"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "MI",
            "license": "4301074795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeland Ear Nose & Thoart",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Berrien Springs, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 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.