LAKEHSORE OTOLARYNGOLOGY (NPI# 1770696379) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770696379 |
| Entity Type | Organization |
| Organization Name | LAKEHSORE OTOLARYNGOLOGY |
| Practice Address |
577 Michigan Avenue Suite 101 Holland MI 49423 |
| Practice Telephone | 6163932190 |
| Practice Fax Number | 6163930147 |
| Mailing Telephone | 6163932190 |
| Mailing Fax Number | 6163930147 |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | THEODORE S VANDERVEEN (PRESIDENT) |
| Authorized Official Telephone | 6163932190 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207YS0123X |
Otolaryngology Specialization: Facial Plastic Surgery |
Allopathic & Osteopathic Physicians |
| Street Address |
577 MICHIGAN AVENUE SUITE 101 |
| City | HOLLAND |
| State | MI |
| Zip Code | 49423 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891715991 | Phillips H Winter | Otolaryngology | 577 Michigan Avenue, Suite 101, Holland, MI 49423 | 2006-07-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356996714 | Ella Rose Marx | Social Worker | 412 Century Lane, Holland, MI 49423 | 2019-08-02 |
| 1245720424 | Amanda Ann Allen | Behavior Technician | 165 Sorrento Drive, Holland, MI 49423 | 2018-05-14 |
| 1588194237 | Emily Amila Geurink | Physical Therapy Assistant | 4037 43rd St, Holland, MI 49423 | 2017-06-15 |
| 1285081737 | Kara Draayer | Nurse Anesthetist, Certified Registered | 25 W 8th St Ste 200, Holland, MI 49423 | 2016-05-14 |
| 1851776413 | Sara Ty | Occupational Therapist | 789 South Meadow Court, Holland, MI 49423 | 2015-07-24 |
| 1508243056 | Andrew Peasley | Chiropractor | 436 Century Ln., Holland, MI 49423 | 2015-05-05 |
| 1437536497 | Deborah Donnelly | Physical Therapy Assistant | 1221 16th Street, Holland, MI 49423 | 2015-04-29 |
| 1366846024 | John Nguyen | Pharmacist | 747 E 16th St, Holland, MI 49423 | 2014-10-09 |
| 1003257817 | Courtney Young | Social Worker | 96 W 15 Street Midtown Center- Arbor Circle, Holland, MI 49423 | 2013-07-09 |
| 1689014391 | Jason Pettet | Acupuncturist | 500 West 17th St., Holland, MI 49423 | 2013-06-26 |
| Find all providers in zip 49423 | ||||
| Taxonomy Code | 207YS0123X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Facial Plastic Surgery |
| An otolaryngologist who specializes in facial plastic surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate was, but is no longer issued by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578768644 | Jason Trygve Stubbs | Otolaryngology | 3100 N. Wellness Dr, Holland, MI 49424 | 2007-06-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215429568 | Hills Ent Institute Pllc | Otolaryngology | 43700 Woodward Ave Ste 201, Bloomfield Hills, MI 48302-5061 | 2018-06-02 |
| 1639402258 | Shant Ara Korkigian | Otolaryngology | 25500 Meadowbrook Rd Ste 220, Novi, MI 48375 | 2009-09-14 |
| 1992914725 | Theodore Alan Golden | Otolaryngology | 755 W Big Beaver, Suite 2111, Troy, MI 48084 | 2007-05-21 |
| 1407992480 | David M Kent | Otolaryngology | 100 Kirts Blvd, Troy, MI 48084-5251 | 2007-01-29 |
| 1356394803 | Northwoods Ear, Nose & Throat PC | Otolaryngology | 2611 Charlevoix Ave, Petoskey, MI 49770-8524 | 2006-05-18 |
| 1174588370 | Richard A Wandzel | Otolaryngology | 222 W Highland Rd, Highland, MI 48357-4504 | 2006-04-19 |
| 1427037282 | Steven Joe Kin | Otolaryngology | 2300 Haggerty Rd Ste 2130, West Bloomfield, MI 48323-2191 | 2006-01-11 |
| 1780112144 | Matthew Wesley Globerson | Otolaryngology | 25500 Meadowbrook Rd, Novi, MI 48375-1878 | 2017-05-30 |
| 1770024630 | Niki Patel | Otolaryngology | 1000 Harrington St, Mount Clemens, MI 48043 | 2017-03-12 |
| 1063951689 | Colin Byrd | Otolaryngology | 50 N Perry St, Pontiac, MI 48342-2217 | 2017-02-15 |
| Find all providers with the same taxonomy | ||||
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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.