# LAKESIDE WOMEN'S SPECIALTY CENTER, APMC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104907807
- **Authorized official:** KATHRYN G WILD M.D. (PRESIDENT)
- **Authorized official phone:** (504) 885-8563

## Contact information

- **Practice address:** 4315 HOUMA BLVD, SUITE 500, METAIRIE, LA 70006-2940
- **Practice address phone:** (504) 885-8563
- **Practice address fax:** (504) 455-1072
- **Mailing address:** 4315 HOUMA BLVD, SUITE 500, METAIRIE, LA 70006-2940
- **Mailing address phone:** (504) 885-8563
- **Mailing address fax:** (504) 455-1072

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/18/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1942561 | — | LA |