Individual
DR. CHARLES R LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD,PHD
Contact information
Practice address
3901RAINBOW BLVD, 4070 DELP, KANSAS CITY, KS 66160
(913) 588-1325
Mailing address
3901RAINBOW BLVD, 4070 DELP, KANSAS CITY, KS 66160
(913) 588-1325
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
04-24437
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19717033
BC/BS
MO
Enumeration date
11/03/2006
Last updated
07/08/2007
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