NPIMap

Organization Active NPI

Lake Michigan ENT PLLC

  • Otolaryngology Physician
  • Muskegon, MI
National Provider Identifier
1881709988
Registry record updated Jan 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
LAKE MICHIGAN ENT PLLC
Practice address
1675 Leahy St
Suite 201a
Muskegon, MI 49442-5500
Phone
(231) 722-4904
Fax
(231) 722-4804
NPI assigned
Aug 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2012

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

Authorized official

Name
Linda Radtke
Title
Biller
Phone
(231) 722-4904

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X Primary

Addresses

Primary practice location

1675 Leahy St
Suite 201a
Muskegon, MI 49442-5500

Mailing address

1675 Leahy St
Suite 201a
Muskegon, MI 49442-5500
Phone (231) 722-4904

National Provider Directory

National Provider Directory

Locations

1675 Leahy St
Ste 315
Muskegon, MI 49442
Phone (231) 728-3344

Practitioners & affiliated clinicians

Practitioners 3

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": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326067200000",
    "number": "1881709988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1675 LEAHY ST",
            "address_2": "SUITE 201A",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494425500",
            "telephone_number": "231-722-4904",
            "fax_number": "231-722-4804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 LEAHY ST",
            "address_2": "SUITE 201A",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494425500",
            "telephone_number": "231-722-4904",
            "fax_number": "231-722-4804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MICHIGAN ENT PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2012-01-09",
        "status": "A",
        "authorized_official_last_name": "RADTKE",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "BILLER",
        "authorized_official_telephone_number": "231-722-4904"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Muskegon, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 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.