Organization
LAKE MI ENT PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA RADTKE (BILLER)
(231) 722-4904
Entity
Organization
Contact information
Practice address
1675 LEAHY ST STE 201A, MUSKEGON, MI 49442-5542
(231) 722-4904
(231) 722-4804
Mailing address
1675 LEAHY ST STE 201A, MUSKEGON, MI 49442-5542
(231) 722-4904
(231) 722-4804
Taxonomy
Speciality
Code
Description
License number
State
332S00000X
Hearing Aid Equipment
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
904711539
—
MI
Enumeration date
05/06/2008
Last updated
05/06/2008
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