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Organization
LAKE CHAMPLAIN PHYSICIAN SERVICES
Active
Organization
LAKE CHAMPLAIN PHYSICIAN SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WOUTER RIETSEMA M.D. (PRESIDENT)
(518) 562-7330
Entity
Organization
Contact information
Practice address
210 CORNELIA ST, SUITE 303, PLATTSBURGH, NY 12901-2318
(518) 562-7541
(518) 562-7542
Mailing address
PO BOX 2868, PLATTSBURGH, NY 12901-0259
(518) 562-7541
(518) 562-7542
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
Other
Enumeration date
11/04/2010
Last updated
11/04/2010
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