Individual
MARK ADRIAN LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15 EXECUTIVE DR, SUITE 4, LAFAYETTE, IN 47905-3833
(765) 838-3428
(765) 838-3440
Mailing address
15 EXECUTIVE DR, SUITE 4, LAFAYETTE, IN 47905-3833
(765) 838-3428
(765) 838-3440
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
01055166
IN
Other
Enumeration date
07/24/2006
Last updated
07/23/2019
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