Organization
LAKE PEDIATRICS PC
Active
Other names
Old Schoolhouse Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARJORIE E LAKE M.D. (CEO/OWNER)
(317) 893-2364
Entity
Organization
Contact information
Practice address
373 MERIDIAN PARKE LN, STE. E, GREENWOOD, IN 46142-9420
(317) 893-2364
(317) 851-8066
Mailing address
373 MERIDIAN PARKE LN, STE. E, GREENWOOD, IN 46142-9420
(317) 893-2364
(317) 851-8066
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200928110A
—
IN
01
—
50005045A
MEDICAL CORPORATION LICENSE
IN
Enumeration date
01/07/2009
Last updated
03/26/2013
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