Organization
LAKESHORE KIDNEY CARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANSUR KHALID PATHAN DO (OWNER)
(734) 366-1361
Entity
Organization
Contact information
Practice address
4811 VENOY RD, WAYNE, MI 48184-2675
(734) 366-1361
(734) 366-1359
Mailing address
46671 PINEHURST CIR, NORTHVILLE, MI 48168-8488
(734) 366-1361
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Enumeration date
04/03/2021
Last updated
04/03/2021
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