Organization
LAKE COUNTRY UROLOGY CLINIC, PLLC
Active
Other names
LAKE COUNTRY HEALTH ALLIANCE
Organization subpart
No
Provider details
NPI number
Authorized official
MARIANO ORCA M.D. (PRESIDENT, PLLC)
(269) 651-4708
Entity
Organization
Contact information
Practice address
17 VINEWOOD AVE, STURGIS, MI 49091-2375
(269) 651-4708
Mailing address
17 VINEWOOD AVE, STURGIS, MI 49091-2375
(269) 651-4708
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4301057100
MI
208000000X
Pediatrics Physician
Primary
4301073697
MI
208800000X
Urology Physician
4301038342
MI
208800000X
Urology Physician
4301082791
MI
Other
Enumeration date
11/20/2006
Last updated
10/17/2007
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