| NPI | 1285339408 |
|---|---|
| Doing Business As | LAKE STATE VEIN AND VASCULAR |
| Entity Type | Organization |
| Authorized Contact | ROBIN FOX Credentialing Manager 248-568-8280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2023-07-11 |