Organization
LAKEFOREST AMBULATORY SURGERY CENTER
Active
Other names
District Heights Ambulatory Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL LAWRENCE MICHETTI DPM (PRESIDENT)
(301) 948-3668
Entity
Organization
Contact information
Practice address
702 RUSSELL AVE, #301, GAITHERSBURG, MD 20877-2606
(301) 948-3668
(301) 926-7787
Mailing address
702 RUSSELL AVE, #301, GAITHERSBURG, MD 20877-2606
(301) 948-3668
(301) 926-7787
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
A1136
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
309595
MEDICARE PROVIDER #
—
01
—
309597
MEDICARE PROVIDER # DH
—
01
—
A1136
MARYLAND LICENSE
MD
Enumeration date
03/20/2007
Last updated
08/22/2020
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