Lake Country Urology Clinic, PLLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

4301073697 Issued in MI

Legal business name

LAKE COUNTRY UROLOGY CLINIC, PLLC

Practice address

17 Vinewood Ave
Sturgis, MI 49091-2375

Phone

(269) 651-4708

NPI assigned

Nov 20, 2006

Organization subpart

No

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

Authorized official

Name

Mariano Orca, M.D.

Title

President, PLLC

Phone

(269) 651-4708

Specialties & licenses 4

Addresses

Other names 1

• LAKE COUNTRY HEALTH ALLIANCE Doing business as

Locations

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192579200000",
    "number": "1972677870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 VINEWOOD AVE",
            "city": "STURGIS",
            "state": "MI",
            "postal_code": "490912375",
            "telephone_number": "269-651-4708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 VINEWOOD AVE",
            "city": "STURGIS",
            "state": "MI",
            "postal_code": "490912375",
            "telephone_number": "269-651-4708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE COUNTRY UROLOGY CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2007-10-17",
        "status": "A",
        "authorized_official_last_name": "ORCA",
        "authorized_official_first_name": "MARIANO",
        "authorized_official_title_or_position": "PRESIDENT, PLLC",
        "authorized_official_telephone_number": "269-651-4708",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301073697",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301057100",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": "MI",
            "license": "4301038342",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": "MI",
            "license": "4301082791",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAKE COUNTRY HEALTH ALLIANCE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Godson G Kotia, M.D.
• Kristy K Davis DO PLLC
• Kroger Limited Partnership I
• Anthony Kuhbander, NP
• Lake Country Health Alliance
• Lake State Dental PLLC
• Alexis Mariah Lance, PHARM. D
• Autumn Lash
• Drew Leer
• Jacob Libby, OTRL

• Pediatrics Physician in Sturgis, MI
• Providers in Sturgis, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; 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.