# LAKESHORE VEIN &LASER CLINIC PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083753479
- **Authorized official:** DR. ANTHONY G FABAZ DO (OWNER)
- **Authorized official phone:** (231) 843-2600

## Contact information

- **Practice address:** 5 N ATKINSON DR, SUITE 304, LUDINGTON, MI 49431-2918
- **Practice address phone:** (231) 843-2600
- **Practice address fax:** (231) 843-2665
- **Mailing address:** 5 N ATKINSON DR, SUITE 304, LUDINGTON, MI 49431-2918
- **Mailing address phone:** (231) 843-2600
- **Mailing address fax:** (231) 843-2665

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 5101006766 | MI | Yes |

## Other

- **Enumeration date:** 02/05/2007
- **Last updated:** 06/18/2009