Organization
LAKE DERMATOLOGY INC.
Active
Organization
LAKE DERMATOLOGY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK ADRIAN LAKE M.D. (PRESIDENT)
(765) 538-3508
Entity
Organization
Contact information
Practice address
15 EXECUTIVE DR, SUITE 4, LAFAYETTE, IN 47905-3833
(765) 838-3428
(765) 838-3440
Mailing address
15 EXECUTIVE DR, SUITE 4, LAFAYETTE, IN 47905-3833
(765) 838-3428
(765) 838-3440
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
01055166A
IN
Other
Enumeration date
04/12/2007
Last updated
11/13/2008
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