Lakeland Family Care of Niles

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LAKELAND FAMILY CARE OF NILES

Practice address

4 Longmeadow Village Dr
Suite 2
Niles, MI 49120-7809

Phone

(269) 684-6000

Fax

(269) 684-1388

NPI assigned

Jun 27, 2008

Last updated

Oct 16, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

FOUR FLAGS HEALTH VENTUREAs reported in NPPES

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

Authorized official

Name

Robin Mack

Title

V.P Operations Physician Services

Phone

(269) 983-8574

Specialties & licenses 1

Addresses

Part of

Niles Pediatrics

Locations

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

{
    "created_epoch": "1214524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224115200000",
    "number": "1649432980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 LONGMEADOW VILLAGE DR",
            "address_2": "SUITE 2",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491207809",
            "telephone_number": "269-684-6000",
            "fax_number": "269-684-1388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 LONGMEADOW VILLAGE DR",
            "address_2": "SUITE 2",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491207809",
            "telephone_number": "269-684-6000",
            "fax_number": "269-684-1388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKELAND FAMILY CARE OF NILES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FOUR FLAGS HEALTH VENTURE",
        "enumeration_date": "2008-06-27",
        "last_updated": "2008-10-16",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "V.P OPERATIONS PHYSICIAN SERVICES",
        "authorized_official_telephone_number": "269-983-8574"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca L Krzysiak, NP
• Macy Kujawa, ATC, LAT
• Andrew Ryan Kutzner, MD
• Kyle McGill DDS PC
• Lakeland Community Hospital Watervliet (Corewell Health Watervliet Hospital Southwestern Medical Multispecial)
• Lakeland General Surgery
• Lakeland Hospitals at Niles and St Joseph, Inc
• Lakeland Hospitals at Niles and St Joseph, Inc (Lakeland Cardiology, Niles)
• Lakeland Housecalls
• Lakeland Immediate Care Center (Niles Community Health Center Pharmacy)

• Family Medicine Physician in Niles, MI
• Providers in Niles, 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 Oct 16, 2008; 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.