Individual
DENNIS LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
710 KENMOOR AVE SE, SUITE 110, GRAND RAPIDS, MI 49546-2379
(616) 949-6112
(616) 949-8530
Mailing address
710 KENMOOR AVE SE, SUITE 110, GRAND RAPIDS, MI 49546-2379
(616) 949-6112
(616) 949-8530
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301039973
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2890360
—
MI
Enumeration date
09/24/2006
Last updated
07/08/2007
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