Organization
LAKESHORE MEDICAL CENTER, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN R PRADKO D.O. (OWNER)
(586) 294-5210
Entity
Organization
Contact information
Practice address
33720 HARPER AVE, SUITE A, CLINTON TWP, MI 48035
(586) 294-5210
(586) 294-0215
Mailing address
33720 HARPER AVE, SUITE A, CLINTON TWP, MI 48035
(586) 294-5210
(586) 294-0215
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3223681
—
MI
05
—
4679899
—
MI
01
—
CH9022
RAILROAD MEDICARE
MI
Enumeration date
10/17/2006
Last updated
10/23/2007
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