# LAKESIDE TRANSPORT GROUP, INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1568895027
- **Authorized official:** MRS. DOMONIQUE CLEMENTS (MANAGER)
- **Authorized official phone:** (248) 228-2266

## Contact information

- **Practice address:** 24724 FARMBROOK RD, SOUTHFIELD, MI 48034-1211
- **Practice address phone:** (248) 228-2266
- **Mailing address:** 24724 FARMBROOK RD, SOUTHFIELD, MI 48034-1211
- **Mailing address phone:** (248) 228-2266

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 347E00000X | Transportation Broker | L1582 | MI | Yes |

## Other

- **Enumeration date:** 08/19/2013
- **Last updated:** 08/19/2013