Organization
HPCN
Active
Other names
HACKLEYLAKES OBGYN
Organization subpart
No
Provider details
NPI number
Authorized official
LAVONNE JONES (OFFICE MANAGER)
(231) 727-7910
Entity
Organization
Contact information
Practice address
1675 LEAHY ST, SUITE 312B, MUSKEGON, MI 49442-5500
(231) 728-1993
(231) 728-1994
Mailing address
1675 LEAHY ST, SUITE 312B, MUSKEGON, MI 49442-5500
(231) 728-1993
(231) 728-1994
Taxonomy
Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160F111510
MI BCBS
MI
Enumeration date
10/25/2006
Last updated
09/16/2008
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