Individual
DR. MICHAEL THOMAS LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5950 SW 81ST ST, MIAMI, FL 33143-8120
(910) 257-4406
Mailing address
5950 SW 81ST ST, MIAMI, FL 33143-8120
(910) 257-4406
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2006-00950
NC
208600000X
Surgery Physician
K8647
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
147WH
BCBSNC
NC
05
—
5909378
—
NC
05
—
N00952
—
SC
Enumeration date
10/27/2005
Last updated
04/05/2014
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