Organization
LAKESHORE ANESTHESIA, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEREK CHEUK MD (PRESIDENT/CEO)
(219) 267-0094
Entity
Organization
Contact information
Practice address
1500 S LAKE PARK AVE, HOBART, IN 46342-6638
(219) 942-0551
Mailing address
PO BOX 11581, FORT WAYNE, IN 46859-1581
(219) 267-0094
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200196230
—
IN
Enumeration date
05/11/2006
Last updated
02/26/2024
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