Organization
LAKESHORE FAMILY MEDICINE ASSOC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG K MACLEAN DO (PRESIDENT)
(716) 947-4851
Entity
Organization
Contact information
Practice address
7060 ERIE RD, DERBY, NY 14047-9306
(716) 947-0408
(716) 947-0413
Mailing address
7060 ERIE RD, DERBY, NY 14047-9306
(716) 947-0408
(716) 947-0413
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
154802
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02288315
—
NY
Enumeration date
09/20/2006
Last updated
07/30/2008
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