NPIMap

Organization Active NPI

Lakeland Medical Practices

  • Dermatology Physician
  • Saint Joseph, MI
National Provider Identifier
1922557347
Registry record updated Sep 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
5101020760 Issued in MI
Legal business name
LAKELAND MEDICAL PRACTICES
Practice address
3901 Stonegate Park
Suite 300
Saint Joseph, MI 49085-9137
Phone
(269) 556-6000
Fax
(269) 556-6020
NPI assigned
Sep 27, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2016

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

Authorized official

Name
Warren White Jr.
Title
Vice President Physician Practices
Phone
(269) 983-8507

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 5101020760 MI Primary

Addresses

Primary practice location

3901 Stonegate Park
Suite 300
Saint Joseph, MI 49085-9137

Mailing address

3901 Stonegate Park
Suite 300
Saint Joseph, MI 49085-9137
Phone (269) 556-6000

Other names 1

  • Stonegate Dermatology 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

NPI Registry JSON

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

{
    "created_epoch": "1474934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474934400000",
    "number": "1922557347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 STONEGATE PARK",
            "address_2": "SUITE 300",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490859137",
            "telephone_number": "269-556-6000",
            "fax_number": "269-556-6020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 STONEGATE PARK",
            "address_2": "SUITE 300",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490859137",
            "telephone_number": "269-556-6000",
            "fax_number": "269-556-6020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKELAND MEDICAL PRACTICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-27",
        "last_updated": "2016-09-27",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "WARREN",
        "authorized_official_title_or_position": "VICE PRESIDENT PHYSICIAN PRACTICES",
        "authorized_official_telephone_number": "269-983-8507",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MI",
            "license": "5101020760",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stonegate Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Joseph, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2016; 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.