# LAKESHORE SURGICAL PRACTICE, PC

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

## Provider details

- **NPI number:** 1578998696
- **Authorized official:** DR. RICHARD J KING MD (PHYSICIAN)
- **Authorized official phone:** (585) 637-2930

## Contact information

- **Practice address:** 30 ERIE CANAL DR, SUITE E, ROCHESTER, NY 14626-4604
- **Practice address phone:** (585) 637-2930
- **Practice address fax:** (585) 637-2930
- **Mailing address:** 1 PARK AVE, BROCKPORT, NY 14420-1913
- **Mailing address phone:** (585) 637-2930
- **Mailing address fax:** (585) 507-4707

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0102X | Surgical Critical Care Physician | 239232 | NY | Yes |

## Other

- **Enumeration date:** 09/09/2013
- **Last updated:** 09/09/2013