Individual
DR. LEANNE LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7695 S 175 W, MILROY, IN 46156-9668
(765) 629-2224
(765) 629-2856
Mailing address
7695 S 175 W, P. O. BOX 398, MILROY, IN 46156-9668
(765) 629-2224
(765) 629-2856
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01036535
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000088990
BCBS
IN
Enumeration date
11/26/2006
Last updated
07/08/2007
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