Organization
LAKE DIAGNOSTICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOEL LEIB D.O. (PRESIDENT/OWNER)
(248) 674-8199
Entity
Organization
Contact information
Practice address
3550 PONTIAC LAKE RD, WATERFORD, MI 48328-2337
(248) 674-8199
(248) 674-8205
Mailing address
3550 PONTIAC LAKE RD, WATERFORD, MI 48328-2337
(248) 674-8199
(248) 674-8205
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013935071
NPI OSTERBERGER
MI
01
—
1205824505
NPI RUBIN
MI
01
—
1346212800
NPI BORIN
MI
01
—
1356349062
NPI SILVERMAN
MI
01
—
1376540286
NPI KACHADURIAN
MI
01
—
1437181146
NPI MELLEN
MI
01
—
1588661391
NPI ELKISS
MI
01
—
1891751509
NPI KOVAN
MI
05
—
3175190-10
—
MI
05
—
3225247-10
—
MI
05
—
4168987-10
—
MI
05
—
4661544-11
—
MI
05
—
4876216-11
—
MI
05
—
4876314-11
—
MI
01
—
700F313270
BCBS GROUP PROVIDER
MI
01
—
CA2712
RAILROAD MEDICARE
MI
Enumeration date
08/11/2006
Last updated
12/08/2011
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