Organization
LAKE SHORE PULMONOLOGY, PLC
Active
Organization
LAKE SHORE PULMONOLOGY, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK JAMES IVEY M.D. (OWNER/PHYSICIAN)
(616) 847-1009
Entity
Organization
Contact information
Practice address
17357 VAN WAGONER RD, SUITE 2, SPRING LAKE, MI 49456-9702
(616) 847-1009
(616) 847-1607
Mailing address
17357 VAN WAGONER RD, SUITE 2, SPRING LAKE, MI 49456-9702
(616) 847-1009
(616) 847-1607
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
4301407127
MI
207RP1001X
Pulmonary Disease Physician
Primary
4301407127
MI
207RS0012X
Sleep Medicine (Internal Medicine) Physician
4301407127
MI
Other
Enumeration date
05/18/2006
Last updated
04/08/2010
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