Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Lake Superior State University

Organization Family Medicine Physician · NPI 1467454199

Lake Superior State University is a Family Medicine Physician in Sault Sainte Marie, Michigan. Registered with an NPI since 2005.

In the registry since
2005
Specialties on file
3

Practice location Address checks out

650 W Easterday Ave
Sault Sainte Marie, MI 49783-1656
Phone: (906) 635-2110
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X
Physician Assistant Taxonomy 363A00000X
Nurse Practitioner Taxonomy 363L00000X

Record details

NPI number1467454199
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kenneth Peress — Vice President Student Affairs · (906) 635-2634
NPI enumeratedAugust 12, 2005
Last updated in NPPESDecember 12, 2008
Mailing address650 W Easterday Ave, Sault Sainte Marie, MI 49783-1656

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