Organization
LAKELAND PROFESSIONAL SERVICES, INC
Active
Other names
Family Care of Niles
Organization subpart
No
Provider details
NPI number
Authorized official
MARY GEEGAN MIDDLETON (EXECUTIVE DIRECTOR)
(269) 684-0259
Entity
Organization
Contact information
Practice address
4 LONG MEADOW VILLAGE LN, SUITE 2, NILES, MI 49120-7808
(269) 684-6000
(269) 684-1388
Mailing address
4 LONG MEADOW VILLAGE LN, SUITE 2, NILES, MI 49120-7808
(269) 684-6000
(269) 684-1388
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CN2908
RAILROAD MEDICARE
—
01
—
OA110150
BC BS GROUP #
MI
Enumeration date
02/03/2006
Last updated
11/20/2007
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