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Organization
LAKEFOREST AMBULATORY SURGERY CENTER
Active
Organization
LAKEFOREST AMBULATORY SURGERY CENTER
Active
Other names
District Heights Ambulatory Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL LAWRENCE MICHETTI DPM (PRESIDENT)
(301) 948-3668
Entity
Organization
Contact information
Practice address
702 RUSSELL AVE, #301, GAITHERSBURG, MD 20877-2606
(301) 948-3668
(301) 926-7787
Mailing address
702 RUSSELL AVE, #301, GAITHERSBURG, MD 20877-2606
(301) 948-3668
(301) 926-7787
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
A1136
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
309595
MEDICARE PROVIDER #
—
01
—
309597
MEDICARE PROVIDER # DH
—
01
—
A1136
MARYLAND LICENSE
MD
Enumeration date
03/20/2007
Last updated
08/22/2020
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