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Organization

LAKESHORE SURGICAL LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ANGELA MICHELLE LEWIS-TRAYLOR MD (CEO)
(832) 916-2422
Entity
Organization

Contact information

Practice address
1207 N HOUSTON AVE, HUMBLE, TX 77338-2591
(832) 916-2422
(832) 916-2522
Mailing address
1207 N HOUSTON AVE, HUMBLE, TX 77338-2591
(832) 916-2422
(832) 916-2522

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2086X0206X
Surgical Oncology Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
370843001
TX
Enumeration date
04/11/2017
Last updated
03/16/2022
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