LAKESHORE VEIN &LASER CLINIC PLLC (NPI# 1083753479) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083753479 |
| Entity Type | Organization |
| Organization Name | LAKESHORE VEIN &LASER CLINIC PLLC |
| Practice Address |
5 N Atkinson Dr Suite 304 Ludington MI 49431-2918 |
| Practice Telephone | 2318432600 |
| Practice Fax Number | 2318432665 |
| Mailing Telephone | 2318432600 |
| Mailing Fax Number | 2318432665 |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2009-06-18 |
| Authorized Official Name | DR. ANTHONY G FABAZ (OWNER) |
| Authorized Official Telephone | 2318432600 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 5101006766 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 1816644 | 05 |
| Street Address |
5 N ATKINSON DR SUITE 304 |
| City | LUDINGTON |
| State | MI |
| Zip Code | 49431-2918 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609861210 | Donald N Schwing | Surgery | 5 N Atkinson Dr, Suite 205, Ludington, MI 49431-2918 | 2005-09-20 |
| 1699224089 | Spectrum Health Primary Care Partners | Psychiatry & Neurology | 5 N Atkinson Dr, Ludington, MI 49431-2918 | 2016-09-26 |
| 1144639360 | Memorial Medical Center of West Michigan | Pediatrics | 5 N Atkinson Dr, Ludington, MI 49431-2918 | 2014-08-13 |
| 1336473230 | Michelle Marie Gentry | Nurse Practitioner | 5 N Atkinson Dr, Suite 2013, Ludington, MI 49431-2918 | 2009-09-24 |
| 1366677783 | R. Joseph Grierson, D.o., Plc | Orthopaedic Surgery | 5 N Atkinson Dr, Suite #200, Ludington, MI 49431-2918 | 2009-05-29 |
| 1568630101 | Margaret E Gustafson Md PC | Specialist | 5 N Atkinson Dr, Suite 203, Ludington, MI 49431-2918 | 2008-02-18 |
| 1669672549 | Dr Daniel G Reum Do PC | Urology | 5 N Atkinson Dr, Suite 205, Ludington, MI 49431-2918 | 2007-07-19 |
| 1669504882 | Persson Internal Medicine,p.c | Internal Medicine | 5 N Atkinson Dr, Suite #207, Ludington, MI 49431-2918 | 2007-03-12 |
| 1568525764 | Anthony G Fabaz | Surgery | 5 N Atkinson Dr, Suite 304, Ludington, MI 49431-2918 | 2006-12-18 |
| 1154409027 | Cheryl M York | Nurse Practitioner | 5 N Atkinson Dr, Suite 201, Ludington, MI 49431-2918 | 2006-11-01 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972006690 | Marti Miller | Physical Therapist | 5916 Iris Rd., Ludington, MI 49431 | 2018-03-09 |
| 1700258670 | Leslie Hahn Ezdebski | Registered Nurse | 318 River St., Suite B, Manistee, MI 49431 | 2015-10-30 |
| 1477888618 | Kathleen M Tooman | Orthotic Fitter | 901 E Tinkham Avenue, Ludington, MI 49431 | 2009-10-06 |
| 1790831592 | Roger Edgren Ostling | Social Worker | 1027 N Rath, Ludington, MI 49431 | 2007-01-25 |
| 1487734364 | Kathryn Jean Niemeyer | Nurse Practitioner | 5 Atkinson Drive, Suite #207, Ludington, MI 49431 | 2006-10-16 |
| 1609986405 | Vivek Thakore | Clinic/Center | 5511 West Us 10 Hwy, Ludington, MI 49431 | 2006-08-30 |
| 1295747756 | Barbara Sleder | Nurse Practitioner | 1 North Atkinson Dr, Ludington, MI 49431 | 2006-08-13 |
| 1083653893 | William L Ingle Dc | Chiropractor | 321 N Jebavy Drive, Ludington, MI 49431 | 2006-06-06 |
| 1366429706 | Andrew S Riemer | Ophthalmology | 5959 Lawndale St, Ludington, MI 49431 | 2005-12-28 |
| 1699240085 | Toby Wessel, Lmsw, Pllc | Social Worker | 612 Sherman Oaks Dr, Ludington, MI 49431 | 2018-10-11 |
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| Taxonomy Code | 208G00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Thoracic Surgery, 2007. http://www.abts.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Thoracic Surgery. Thoracic surgeons have the knowledge, experience and technical skills to accurately diagnose, operate upon safely, and effectively manage patients with thoracic diseases of the chest. This requires substantial knowledge of cardiorespiratory physiology and oncology, as well as capability in the use of heart assist devices, management of abnormal heart rhythms and drainage of the chest cavity, respiratory support systems, endoscopy and invasive and noninvasive diagnostic techniques. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710479191 | United Surgical Associates Pllc | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2150 Association Dr, Okemos, MI 48864-4909 | 2018-06-01 |
| 1841719531 | Liberty Cardiolvascular Group Pllc | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 5250 Auto Club Dr Ste 300l, Dearborn, MI 48126-2619 | 2017-09-13 |
| 1710411293 | Abdul Hassan | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 11 Chateaux Du Lac, Fenton, MI 48430 | 2017-04-12 |
| 1871982249 | Michigan Heart Lung and Vein Surgery | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2757 Leonard Ne, Ste 200, Grand Rapids, MI 49525-5807 | 2015-01-22 |
| 1154767382 | Michigan Thoracic Institute, PC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 6640 Kings Ct, West Bloomfield, MI 48322-2779 | 2013-05-15 |
| 1679815898 | Hanna Park | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 100 Michigan St Ne Rm 8830, Grand Rapids, MI 49503 | 2013-03-26 |
| 1760730469 | Hurley Medical Center | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1125 S. Linden Road, Suite 700, Flint, MI 48532-4069 | 2012-08-28 |
| 1245588326 | Bakri Kaakeh | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4701 Towne Centre Rd Ste 301, Saginaw, MI 48604-2800 | 2012-08-21 |
| 1447521554 | Eduardo Arciniegas | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 3236 Interlaken St, West Bloomfield, MI 48323-1824 | 2012-01-20 |
| 1629358650 | Steven S. Demos | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 3739 Highgate Rd, Norton Shores, MI 49441-5017 | 2011-08-22 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.