Individual
HAROLD J LAKE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1105 SIXTH ST, TRAVERSE CITY, MI 49684-2345
(231) 935-8686
(231) 935-8707
Mailing address
1105 SIXTH ST, TRAVERSE CITY, MI 49684-2345
(231) 935-8686
(231) 935-8707
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5601005633
MI
363AM0700X
Medical Physician Assistant
Primary
5601005633
MI
Other
Enumeration date
09/18/2009
Last updated
12/13/2021
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