Jon M Lake, M.D. Valid NPI
Individual provider · Family Medicine Physician · Jackson, MI
- NPI
- 1376561696
- Type
- Individual (Type 1)
- Primary specialty
- Family Medicine Physician (Family Medicine)
- Specialty group
- Allopathic & Osteopathic Physicians
- Taxonomy code
- 207Q00000X
- License number
- 4301068180 (MI)
- Sex
- Male
- Sole proprietor
- No
- Enumerated
- 2006-07-17
- Last updated
- 2021-02-17
Practice location
400 Hinckley Blvd, Suite 100
Jackson, MI 49203-6125
(517) 784-0588