Organization
LAKESHORE SURGICAL CONSULTANTS, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY AMES JR. (TREASURER)
(734) 250-0610
Entity
Organization
Contact information
Practice address
5400 FORT ST, SUITE 200, TRENTON, MI 48183-4632
(734) 250-0610
(734) 676-4407
Mailing address
25432 7TH ST, GROSSE ILE, MI 48138-1808
(734) 250-0610
(734) 676-4407
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
2086S0102X
Surgical Critical Care Physician
—
—
2086S0120X
Pediatric Surgery Physician
—
—
2086S0127X
Trauma Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
Other
Enumeration date
02/26/2014
Last updated
02/26/2014
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