| Lake Medical Group | |
|
2001 Lake Ave Pueblo CO 81004-3538 | |
| (719) 564-0300 | |
| (719) 564-0303 |
| Full Name | Lake Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 2001 Lake Ave, Pueblo, Colorado |
| Authorized Official Name and Position | Melchor Sipalay (OWNER) |
| Authorized Official Contact | 7195640300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Medical Group 2001 Lake Ave Pueblo CO 81004-3538 Ph: (719) 564-0300 | Lake Medical Group 2001 Lake Ave Pueblo CO 81004-3538 Ph: (719) 564-0300 |
| NPI Number | 1003012279 |
|---|---|
| Provider Enumeration Date | 06/25/2007 |
| Last Update Date | 05/16/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003012279 | NPI | - | NPPES |
| 56483872 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 38338 (Colorado) | Primary |
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