Individual
EMMA LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
905 N MAIN ST, ADRIAN, MI 49221-2173
(517) 295-1066
Mailing address
14671 TELEGRAPH RD, REDFORD, MI 48239-3300
(313) 948-3055
(313) 948-3041
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
06/15/2021
Last updated
06/15/2021
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