Individual
MR. LANCE LINCOLN PRIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
601 JOHN ST STE M-460, KALAMAZOO, MI 49007-5355
(269) 341-7333
(269) 341-7371
Mailing address
5301 E HURON RIVER DR, YPSILANTI, MI 48197-1051
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601006118
MI
363AS0400X
Surgical Physician Assistant
5601006118
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10111084P
SENTARA HEALTH PLANS
VA
01
—
14374322036
TRICARE
VA
05
—
14374322036
—
VA
01
—
VV9406A
MEDICARE PTAN
VA
Enumeration date
09/21/2011
Last updated
11/27/2023
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