Organization
LAKE COUNTRY HEALTH ALLIANCE
Active
Parent organization
LAKE COUNTRY UROLOGY CLINIC
Other names
LAKE COUNTRY UROLOGY CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAKE COUNTRY UROLOGY CLINIC
Authorized official
MARIANO ORCA MD (MD)
(269) 651-4708
Entity
Organization
Contact information
Practice address
17 VINEWOOD AVE, STURGIS, MI 49091-2375
(269) 651-4708
Mailing address
17 VINEWOOD AVE, STURGIS, MI 49091-2375
(269) 651-4708
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
08/06/2007
Last updated
08/06/2007
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