Organization · Type 2 NPI
Lakeside Internal Medicine PC
Primary Care Clinic/Center · St. Clair Shores, MI
NPI number
1386840502
Active
Practice location
21519 Harper Ave Ste 109
St. Clair Shores, MI 48080-2209
Mailing address
21519 Harper Ave, Suite 109
St. Clair Shores, MI 48080-2220
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Primary Care Clinic/Center Primary | 261QP2300X | 4301058249 (MI) |
Primary Care Clinic/Center: Definition to come...
2 other providers at this address
Other primary care clinic/center providers in St. Clair Shores
About NPI 1386840502
Lakeside Internal Medicine PC's National Provider Identifier is 1386840502, issued on Jun 25, 2007. The primary taxonomy on file is Primary Care Clinic/Center (261QP2300X), and the practice location is in St. Clair Shores, MI. The record was last updated on Aug 18, 2014.