# LAKE COUNTRY UROLOGY CLINIC, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LAKE COUNTRY HEALTH ALLIANCE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528190303
- **Authorized official:** MARIANO L ORCA M.D. (PRESIDENT, PLLC)
- **Authorized official phone:** (269) 651-4708

## Contact information

- **Practice address:** 420 W HIGH ST, DOWAGIAC, MI 49047-1943
- **Practice address phone:** (269) 651-4708
- **Mailing address:** 17 VINEWOOD AVE, STURGIS, MI 49091-2375
- **Mailing address phone:** (269) 651-4708

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | — | NULL | Yes |
| 208800000X | Urology Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/09/2007
- **Last updated:** 10/17/2007