NPI 1770696379

Lakehsore Otolaryngology

Organisation Facial Plastic Surgery Physician Holland, MI

Practice location

Address: 577 Michigan Avenue Suite 101, Holland, MI 49423
Phone: (616) 393-2190
Fax: (616) 393-0147

Authorised official

Name: Theodore S Vanderveen
Title: President
Phone: (616) 393-2190

Registered specialties

Facial Plastic Surgery Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207YS0123X

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Registry record

NPI: 1770696379
Entity type: Organization
NPI issued: 16 Aug 2006
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.