Organization
LAKE DIAGNOSTICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOEL LEIB D.O. (PRESIDENT)
(248) 626-0766
Entity
Organization
Contact information
Practice address
3550 PONTIAC LAKE RD, WATERFORD, MI 48328-2337
(248) 674-8199
(248) 674-8205
Mailing address
31800 NORTHWESTERN HWY, SUITE 370, FARMINGTON HILLS, MI 48334-1655
(248) 626-0766
(248) 626-7498
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
COFEG
BILLING LOCATOR CODE
MI
Enumeration date
06/18/2006
Last updated
07/21/2022
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