Individual
STEPHEN GARY LALKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 205-7481
(313) 876-1305
Mailing address
PO BOX 601067, CHARLOTTE, NC 28260-1067
(704) 355-8188
(704) 355-8192
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01035930A
IN
208600000X
Surgery Physician
2005-01060
NC
2086S0129X
Vascular Surgery Physician
01035930A
IN
2086S0129X
Vascular Surgery Physician
2005-01060
NC
2086S0129X
Vascular Surgery Physician
Primary
4301500422
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194737478
—
NC
01
—
1396N
BCBS
NC
05
—
5901224
—
NC
05
—
N0106A
—
SC
01
—
P00245249
RAILROAD MEDICARE
—
Enumeration date
08/13/2006
Last updated
08/01/2022
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