| Lakeside Internal Medicine Pc | |
|
21519 Harper Ave Ste 109 Saint Clair Shores MI 48080-2209 | |
| (586) 945-5012 | |
| Not Available |
| Full Name | Lakeside Internal Medicine Pc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 21519 Harper Ave Ste 109, Saint Clair Shores, Michigan |
| Authorized Official Name and Position | Paul Antony (PRESIDENT) |
| Authorized Official Contact | 5867785287 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Internal Medicine Pc 21519 Harper Ave Suite 109 Saint Clair Shores MI 48080-2220 Ph: (586) 447-3017 | Lakeside Internal Medicine Pc 21519 Harper Ave Ste 109 Saint Clair Shores MI 48080-2209 Ph: (586) 945-5012 |
| NPI Number | 1386840502 |
|---|---|
| Provider Enumeration Date | 06/25/2007 |
| Last Update Date | 08/18/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386840502 | NPI | - | NPPES |
| 5199450 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 4301058249 (Michigan) | Primary |
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