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Organization
LAKESIDE HEART AND LUNG CENTER, INC.
Active
Organization
LAKESIDE HEART AND LUNG CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY DERISO II M.D. (DIRECTOR/ OWNER)
(419) 609-8000
Entity
Organization
Contact information
Practice address
703 TYLER ST, STUITE 252, SANDUSKY, OH 44870-3367
(419) 609-8000
(419) 609-8002
Mailing address
703 TYLER ST, STE 252, SANDUSKY, OH 44870-3367
(419) 609-8000
(419) 609-8002
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
NULL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0883469
—
OH
Enumeration date
10/20/2006
Last updated
04/23/2012
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