Michael Thomas Lake, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

2006-00950 Issued in NC

Practice address

5950 SW 81St St
Miami, FL 33143-8120

Phone

(910) 257-4406

NPI assigned

Oct 27, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396656000000",
    "number": "1730179045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5950 SW 81ST ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331438120",
            "telephone_number": "910-257-4406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5950 SW 81ST ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331438120",
            "telephone_number": "910-257-4406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "MICHAEL",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-27",
        "last_updated": "2014-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "K8647",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NC",
            "license": "2006-00950",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "147WH",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N00952",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5909378",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Laing
• Lajas Medical Supply Corp
• Taylor Nicole Lakatis
• Lake Catherine Holdings LLC
• Gaspar Dixan Lake Perez
• Norma Salenah Lake, MD
• Rose Mary Lake
• Lakes Psychiatry LLC
• Lakeside Neurology and Radiology
• Lakeview Alf, Corp.

• Surgery Physician in Miami, FL
• Providers in Miami, FL by specialty
• Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2014; 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.