Organization
LAKESIDE INTERNAL MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL ANTONY (PRESIDENT)
(586) 778-5287
Entity
Organization
Contact information
Practice address
21519 HARPER AVE STE 109, SAINT CLAIR SHORES, MI 48080-2209
(586) 945-5012
Mailing address
21519 HARPER AVE, SUITE 109, SAINT CLAIR SHORES, MI 48080-2220
(586) 447-3017
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
4301058249
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5199450
—
MI
Enumeration date
06/25/2007
Last updated
08/18/2014
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