Organization
LAKEVIEW MEDICAL CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAGDY WANIS MD (OWNER)
(586) 585-2570
Entity
Organization
Contact information
Practice address
23600 HARPER AVE, STE. 103, SAINT CLAIR SHORES, MI 48080-1445
(586) 585-2570
(586) 585-2574
Mailing address
23600 HARPER AVE, STE. 103, SAINT CLAIR SHORES, MI 48080-1445
(586) 585-2570
(586) 585-2574
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110500795-2
BCBS
—
01
—
127679
CARE CHOICES
—
01
—
21969
HEALTH PLAN OF MICHIGAN
—
05
—
4243830
—
MI
01
—
7189170
AETNA
—
01
—
912517500
MEDICAID FLORIDA
—
01
—
G89641
HAP
—
01
—
P00051536
MEDICARE RR
—
01
—
P105025
BCN
—
Enumeration date
04/16/2010
Last updated
04/16/2010
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