| Jon M Lake, MD | |
|
400 Hinckley Blvd, Suite 100, Jackson, MI 49203-6125 | |
| (517) 784-0588 | |
| (517) 784-3866 |
| Full Name | Jon M Lake |
|---|---|
| Gender | Male |
| Speciality | Family Medicine |
| Location | 400 Hinckley Blvd, Jackson, Michigan |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376561696 | NPI | - | NPPES |
| P00420975 | Other | MI | RR MEDICARE |
| 80169124 | Other | MI | RR MEDICARE |
| 5187092-10 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 4301068180 (Michigan) | Primary |
| Entity Name | Independent Emergency Physicians Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1780791343 PECOS PAC ID: 6709798325 Enrollment ID: O20031103000407 |
| Entity Name | W.a. Foote Memorial Hospital, Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1760437826 PECOS PAC ID: 0244136067 Enrollment ID: O20031212000691 |
| Entity Name | Center For Family Health |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1780784439 PECOS PAC ID: 4587574421 Enrollment ID: O20040219000916 |
| Entity Name | Iep - Post Acute Care Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1760166821 PECOS PAC ID: 0648631812 Enrollment ID: O20230803003290 |
| Mailing Address | Practice Location Address |
|---|---|
| Jon M Lake, MD Po Box 67000, Department 272801, Detroit, MI 48267-0002 Ph: (517) 784-0588 | Jon M Lake, MD 400 Hinckley Blvd, Suite 100, Jackson, MI 49203-6125 Ph: (517) 784-0588 |
Rubana Khan, DO Family Medicine Medicare: Medicare Enrolled Practice Location: 205 N East Ave, Jackson, MI 49201 Phone: 810-931-5407 | |
Dr. Rene Cardenas, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 1401 W North St, Jackson, MI 49202 Phone: 517-782-2555 | |
Erin Nicole Murfey, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 400 Hinckley Blvd, Ste 100, Jackson, MI 49203 Phone: 517-784-0141 Fax: 517-787-3462 | |
Maria Soto, DO Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1401 W North St, Jackson, MI 49202 Phone: 517-782-2555 Fax: 517-782-3399 | |
Mohamed El Fakiy, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 205 N East Ave, Jackson, MI 49201 Phone: 816-394-6643 | |
Dr. Robert N Israel, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 124 Seymour Ave, Jackson, MI 49202 Phone: 517-782-5700 Fax: 517-782-3141 | |
Wardha Shabbir, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 205 N East Ave, Jackson, MI 49201 Phone: 517-205-4800 |