Individual
KEVIN C LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPA
Contact information
Practice address
475 IRVING AVE, SUITE 418, SYRACUSE, NY 13210-1756
(315) 426-0190
(315) 426-0192
Mailing address
475 IRVING AVE, SUITE 418, SYRACUSE, NY 13210-1756
(315) 426-0190
(315) 426-0192
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
010298
NY
Other
Enumeration date
04/07/2006
Last updated
06/18/2009
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