Organization
LAKESHORE ALLERGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE ANN HUTSON MD (OWNER OPERATOR PHYSICIAN)
(616) 738-4262
Entity
Organization
Contact information
Practice address
3290 N WELLNESS, BLDG D STE 180, HOLLAND, MI 49424
(616) 738-4262
(616) 738-4266
Mailing address
3290 N WELLNESS, BLDG D STE 180, HOLLAND, MI 49424
(616) 738-4262
(616) 738-4266
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
4301051148
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0030084
BCBS
—
05
—
4604806
—
MI
01
—
P105210
BLUECH
—
Enumeration date
07/01/2006
Last updated
02/27/2012
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