Organization
LAKESIDE HEART AND LUNG CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY DERISO II M.D. (DIRECTOR/ OWNER)
(419) 609-8000
Entity
Organization
Contact information
Practice address
703 TYLER ST, STUITE 252, SANDUSKY, OH 44870-3367
(419) 609-8000
(419) 609-8002
Mailing address
703 TYLER ST, STE 252, SANDUSKY, OH 44870-3367
(419) 609-8000
(419) 609-8002
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0883469
—
OH
Enumeration date
10/20/2006
Last updated
04/23/2012
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