Lake Dermatology Inc.

NPI #1689898447 in Lafayette, Indiana

Provider Information

NPI Number
1689898447
Entity Type
Organization
Organization Name
Lake Dermatology Inc.
Primary Specialty
Dermatology
Enumeration Date
Apr 12, 2007
Last Updated
Nov 13, 2008

Practice Location

Address
15 EXECUTIVE DR
Address 2
SUITE 4
State
Indiana
ZIP Code
47905-3833
Phone
(765) 838-3428

Authorized Official

Name
MARK ADRIAN LAKE, M.D.
Title
PRESIDENT
Phone
(765) 538-3508

Specialties & Taxonomy Codes

Specialty
Dermatology

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