Individual
MICHAEL WOLFGANG LAKE
Active
Individual
MICHAEL WOLFGANG LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125.063687
IL
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
MD460603
PA
207RP1001X
Pulmonary Disease Physician
Primary
MD460603
PA
Other
Enumeration date
04/03/2013
Last updated
06/12/2019
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