# LAKE INTERNAL MED SPECIAL

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

## Provider details

- **NPI number:** 1275719627
- **Authorized official:** DR. M DAVID EAST D.O. (OWNER)
- **Authorized official phone:** (573) 348-6700

## Contact information

- **Practice address:** 980 EXECUTIVE DR, SUITE D, OSAGE BEACH, MO 65065-3495
- **Practice address phone:** (573) 348-6700
- **Practice address fax:** (573) 348-3310
- **Mailing address:** 980 EXECUTIVE DR, SUITE D, OSAGE BEACH, MO 65065-3495
- **Mailing address phone:** (573) 348-6700
- **Mailing address fax:** (573) 348-3310

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | RIE24 | MO | Yes |

## Other

- **Enumeration date:** 01/16/2008
- **Last updated:** 01/16/2008