LAKE DERMATOLOGY INC. (NPI# 1689898447) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689898447 |
| Entity Type | Organization |
| Organization Name | LAKE DERMATOLOGY INC. |
| Practice Address |
15 Executive Dr Suite 4 Lafayette IN 47905-3833 |
| Practice Telephone | 7658383428 |
| Practice Fax Number | 7658383440 |
| Mailing Telephone | 7658383428 |
| Mailing Fax Number | 7658383440 |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2008-11-13 |
| Authorized Official Name | MARK ADRIAN LAKE (PRESIDENT) |
| Authorized Official Telephone | 7655383508 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 01055166A | IN | Allopathic & Osteopathic Physicians |
| Street Address |
15 EXECUTIVE DR SUITE 4 |
| City | LAFAYETTE |
| State | IN |
| Zip Code | 47905-3833 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194756890 | Barbara A. Osborn | Social Worker | 15 Executive Dr, Ste 3, Lafayette, IN 47905-4868 | 2006-07-05 |
| 1285943928 | National Mentor Healthcare, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 15 Executive Dr, Ste 1, Lafayette, IN 47905-3833 | 2010-09-29 |
| 1104848423 | Mark Adrian Lake | Dermatology | 15 Executive Dr, Suite 4, Lafayette, IN 47905-3833 | 2006-07-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538719893 | Elements Counseling LLC | Social Worker | 115 N. Farabee Drive, Lafayette, IN 47905 | 2019-09-18 |
| 1134596869 | Indiana Dental Sleep Therapy LLC | Dentist | 4921 Sr 26 E, Suite 300, Lafayette, IN 47905 | 2015-08-28 |
| 1255750899 | Emily S Miller | Physical Therapist | 1701 Creasy Ln, Lafayette, IN 47905 | 2014-04-10 |
| 1073876215 | Nathan Webster | Dentist | 1530 Kossuth St., Lafayette, IN 47905 | 2012-06-22 |
| 1578848370 | Mark Jin Kim | Pharmacist | 1801 South St., Lafayette, IN 47905 | 2011-10-13 |
| 1700177185 | Shannon Tawn Harris | Speech-Language Pathologist | 8900 Cobbler Lane, Lafayette, IN 47905 | 2011-04-20 |
| 1508164484 | David Thomas Beine | Specialist/Technologist | 1321 Unity Pl Ste A, Lafayette, IN 47905 | 2011-03-02 |
| 1447569538 | Deidre Dudley | Nurse Practitioner | 1701 S Creasy Ln Ste 1w93, Lafayette, IN 47905 | 2010-10-07 |
| 1548493067 | Unity Healthcare, LLC | Podiatrist | 750 Park East Blvd, Unit 4, Lafayette, IN 47905 | 2009-09-01 |
| 1073762969 | Lynette Marie Alexander | Nurse Practitioner | 5500 St Rd. 38 East, Lafayette, IN 47905 | 2008-09-16 |
| Find all providers in zip 47905 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982098836 | Tyson Meaux | Dermatology | 101 Rue Fontaine, Lafayette, LA 70508-5744 | 2015-03-27 |
| 1164773172 | Lafayette Dermatology, LLC | Dermatology | 91 Settlers Trace Blvd., Bldg. 3, Lafayette, LA 70508 | 2012-10-01 |
| 1831458363 | Blair Budden | Dermatology | 91 Settlers Trace Blvd Ste 3, Lafayette, LA 70508-6090 | 2012-05-03 |
| 1265746788 | Erlinda K. Sy Fang | Dermatology | 1115 Via Media, Lafayette, CA 94549-2921 | 2010-07-27 |
| 1437474772 | John Charles Chapman | Dermatology | 101 Rue Fontaine Bldg 4, Lafayette, LA 70508-5744 | 2010-03-30 |
| 1831352418 | Jessica Yoon | Dermatology | 2770 Arapahoe Rd Ste 132-1036, Lafayette, CO 80026-8018 | 2008-07-03 |
| 1528252681 | Frankie Guillot Rholdon | Dermatology | 91 Settlers Trace Blvd, Bldg 3, Lafayette, LA 70508-6089 | 2007-08-31 |
| 1194757518 | Swan Dermatology Center, PC | Dermatology | 2020 Union St., Suite 300, Lafayette, IN 47904 | 2006-07-07 |
| 1104865286 | Kelly T. Hood | Dermatology | 970 Dewing Ave, Suite 301, Lafayette, CA 94549 | 2006-06-05 |
| 1720030091 | Christopher Raymond Hubbell | Dermatology | 309 Settlers Trace Blvd, Suite 100, Lafayette, LA 70508 | 2006-05-16 |
| Find all providers in LAFAYETTE | ||||
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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.