LAKESIDE INTERNAL MEDICINE PC NPI 1386840502

NPI Information

NPI: 1386840502
Provider Name: LAKESIDE INTERNAL MEDICINE PC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
21519 HARPER AVE STE 109
SAINT CLAIR SHORES, MI
ZIP 48080
Phone: (586) 945-5012
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LAKESIDE INTERNAL MEDICINE PC is a primary care clinic center in Saint Clair Shores, MI. LAKESIDE INTERNAL MEDICINE PC NPI is 1386840502. The provider is registered as an organization entity type.

The provider's business location address is:

21519 HARPER AVE STE 109
SAINT CLAIR SHORES, MI
ZIP 48080-209
Phone: (586) 945-5012

The provider's authorized official is Paul Antony .
The authorized official title is President and has the following contact phone number (586) 778-5287.

The enumeration date for this NPI number is 6/25/2007 and was last updated on 8/18/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	4301058249	MICHIGAN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	5199450	MEDICAID	MICHIGAN
2	0M17390	MEDICARE PIN	MICHIGAN
3	G16772	MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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