Lakeside Internal Medicine Pc

LBN: Lakeside Internal Medicine Pc
Lakeside Internal Medicine Pc is an health care organization with primary practice located at 21519 Harper Ave Ste 109 , Saint Clair Shores MI 48080-2209. The organization recently has only one registered license in Ambulatory Health Care Facilities / Primary Care, which is considered as the primary health care specialty. Lakeside Internal Medicine Pc can be contacted via phone (586) 945-5012, or through Antony, Paul via phone (586) 778-5287.

Contact Information

Primary practice address
21519 Harper Ave Ste 109 Saint Clair Shores MI 48080-2209
Phone: (586) 945-5012
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Antony, Paul
Phone: (586) 778-5287

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Primary Care 261QP2300X 4301058249 Michigan

Profile Details

NPI number 1386840502
LBN Legal business name Lakeside Internal Medicine Pc
DBA Doing business as
Authorized official Antony, Paul
Entity Organization
Organization subpart 1 No
Enumeration date Jun 25th, 2007
Last updated Aug 18th, 2014 - about 10 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386840502 NPPES
Michigan MEDICAID 5199450

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