Organization
LAKESIDE CANCER SPECIALISTS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDMUND BRIAN PALOYAN M.D. (OWNER)
(269) 428-4411
Entity
Organization
Contact information
Practice address
3950 HOLLYWOOD RD, SUITE 240, SAINT JOSEPH, MI 49085-9151
(269) 428-4411
(269) 428-4422
Mailing address
3950 HOLLYWOOD RD, SUITE 240, SAINT JOSEPH, MI 49085-9151
(269) 428-4411
(269) 428-4422
Taxonomy
Speciality
Code
Description
License number
State
261QX0200X
Oncology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0P42500
MEDICARE ID
—
Enumeration date
02/21/2007
Last updated
07/20/2009
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