Organization
LAKESHORE SLEEP MEDICINE PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NATHAN CRAIG BOSS M.D. (PHYSICIAN)
(231) 547-3124
Entity
Organization
Contact information
Practice address
14700 LAKE SHORE DR, CHARLEVOIX, MI 49720-1931
(231) 547-3124
Mailing address
14700 LAKE SHORE DR, CHARLEVOIX, MI 49720-1931
(231) 547-3124
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301069390
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080151722-1
BCBS OF MI
MI
05
—
104941225
—
MI
01
—
900034219
PRIORITY HEALTH
MI
Enumeration date
08/17/2006
Last updated
12/05/2011
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