Organization
MICROSURGERY INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG WAYNE LAKE (ADMINISTRATOR)
(214) 350-2400
Entity
Organization
Contact information
Practice address
5920 FOREST PARK RD STE 700, DALLAS, TX 75235-6414
(214) 350-2400
(214) 352-4862
Mailing address
5920 FOREST PARK RD STE 700, DALLAS, TX 75235-6414
(214) 350-2400
(214) 352-4862
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
09/13/2010
Last updated
09/20/2010
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