Organization
LAKESHORE SPINE AND PAIN P C
Active
Other names
Lakeshore Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
RAJ C MAKWANA (ADMINISTRATOR)
(231) 843-1553
Entity
Organization
Contact information
Practice address
5511 W US HIGHWAY 10, LUDINGTON, MI 49431-2455
(231) 843-1553
(231) 845-7056
Mailing address
5511 W US HIGHWAY 10, LUDINGTON, MI 49431-2455
(231) 843-1553
(231) 845-5515
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700E310160
BCBS GROUP NUMBER
MI
Enumeration date
07/04/2006
Last updated
06/03/2011
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