Organization
LAKESHORE DERM & LASER CENTER PLC
Active
Organization
LAKESHORE DERM & LASER CENTER PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON BARRETT VAN ITTERSUM M.D. (OWNER)
(231) 798-9500
Entity
Organization
Contact information
Practice address
6225 PRAIRIE ST, NORTON SHORES, MI 49444-7831
(231) 798-9500
(231) 798-9533
Mailing address
6225 PRAIRIE ST, NORTON SHORES, MI 49444-7831
(231) 798-9500
(231) 798-9533
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
—
MI
Other
Enumeration date
02/07/2007
Last updated
10/22/2013
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