# LAKESIDE ANESTHESIOLOGY, SC

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

## Provider details

- **NPI number:** 1306892377
- **Authorized official:** DAVID S FOOTERMAN MD (PRESIDENT)
- **Authorized official phone:** (815) 633-8586

## Contact information

- **Practice address:** 6090 STRATHMOOR DR, ROCKFORD, IL 61107-6628
- **Practice address phone:** (815) 633-8586
- **Mailing address:** 6785 WEAVER RD, ROCKFORD, IL 61114-8055
- **Mailing address phone:** (815) 633-8586

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | — |
| 207L00000X | Anesthesiology Physician | — | — | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/25/2006
- **Last updated:** 06/06/2011