Organization
LAKE SUPERIOR STATE UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH PERESS PHD (VICE PRESIDENT STUDENT AFFAIRS)
(906) 635-2634
Entity
Organization
Contact information
Practice address
650 W EASTERDAY AVE, SAULT SAINTE MARIE, MI 49783-1656
(906) 635-2110
Mailing address
650 W EASTERDAY AVE, SAULT SAINTE MARIE, MI 49783-1656
(906) 635-2110
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
08/12/2005
Last updated
12/12/2008
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