Organization
LAKESIDE MEDICAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN L HARTZ D.O. (PRESIDENT)
(248) 628-0220
Entity
Organization
Contact information
Practice address
72 S WASHINGTON ST, SUITE 202, OXFORD, MI 48371-4973
(248) 628-0220
(248) 628-0226
Mailing address
72 S WASHINGTON ST, SUITE 202, OXFORD, MI 48371-4973
(248) 628-0220
(248) 628-0226
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
SH007361
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0856300954
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
01
—
207Q00000X
TAXONOMY
MI
05
—
291878311
—
MI
Enumeration date
03/20/2007
Last updated
06/30/2008
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