Lake Superior State University
NPI #1467454199 in Sault Sainte Marie, Michigan
Provider Information
- NPI Number
- 1467454199
- Entity Type
- Organization
- Organization Name
- Lake Superior State University
- Primary Specialty
- Family Medicine
- Enumeration Date
- Aug 12, 2005
- Last Updated
- Dec 12, 2008
Practice Location
- Address
- 650 W EASTERDAY AVE
- State
- Michigan
- ZIP Code
- 49783-1656
- Phone
- (906) 635-2110
Authorized Official
- Name
- KENNETH PERESS, PHD
- Title
- VICE PRESIDENT STUDENT AFFAIRS
- Phone
- (906) 635-2634
Specialties & Taxonomy Codes
| Specialty |
|---|
| Nurse Practitioner |
| Physician Assistant |
| Family Medicine |
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