# LAKESHORE UROLOGY PLC

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

## Provider details

- **NPI number:** 1275872509
- **Authorized official:** CALEB J FLEMING MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (616) 604-8363

## Contact information

- **Practice address:** 1445 SHELDON RD, SUITE 102, GRAND HAVEN, MI 49417-2480
- **Practice address phone:** (616) 604-8363
- **Practice address fax:** (616) 604-8364
- **Mailing address:** 1445 SHELDON RD, SUITE 102, GRAND HAVEN, MI 49417-2480
- **Mailing address phone:** (616) 604-8363
- **Mailing address fax:** (616) 604-8364

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | 4301048869 | MI | Yes |

## Other

- **Enumeration date:** 02/06/2013
- **Last updated:** 02/15/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 101995044 | — | MI |