Provider Demographics
NPI:1679575377
Name:HAKE, LAWRENCE W (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:W
Last Name:HAKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N ALPHA ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4316
Mailing Address - Country:US
Mailing Address - Phone:308-381-0473
Mailing Address - Fax:308-381-2616
Practice Address - Street 1:620 N ALPHA ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4316
Practice Address - Country:US
Practice Address - Phone:308-381-0473
Practice Address - Fax:308-381-2616
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14374208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE7241OtherBCBS
NE7241OtherBCBS
NE095007HAMedicare ID - Type Unspecified
NE47070756913Medicare ID - Type Unspecified