Organization
LAKESHORE DIAGNOSTICS ULTRASOUND CO.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM E BERNER (PRESIDENT)
(989) 892-8444
Entity
Organization
Contact information
Practice address
1003 WOODSIDE AVE, ESSEXVILLE, MI 48732-1234
(989) 892-8444
(989) 892-7455
Mailing address
1003 WOODSIDE AVE, ESSEXVILLE, MI 48732-1234
(989) 892-8444
(989) 892-7455
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104997089
—
MI
05
—
113012847
—
MI
05
—
3012847
—
MI
01
—
310Z910630
BLUE CROSS UPIN
MI
05
—
4997089
—
MI
05
—
718550205
—
MO
Enumeration date
11/11/2005
Last updated
02/07/2013
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