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Organization

LAKESIDE HEALTHCARE SPECIALISTS PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SHARON DESKINS MD (PHYSICIAN OWNER)
(269) 983-0500
Entity
Organization

Contact information

Practice address
3950 HOLLYWOOD RD, SUITE 270, SAINT JOSEPH, MI 49085-9159
(269) 983-0500
(269) 429-2240
Mailing address
3950 HOLLYWOOD RD, SUITE 270, SAINT JOSEPH, MI 49085-9159
(269) 983-0500
(269) 429-2240

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
AP062392
MI
207R00000X
Internal Medicine Physician
DP065168
MI
207R00000X
Internal Medicine Physician
KA036485
MI
207R00000X
Internal Medicine Physician
Primary
MS007105
MI
207R00000X
Internal Medicine Physician
SD062237
MI
207R00000X
Internal Medicine Physician
SW015533
MI
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
VS046079
MI
207RP1001X
Pulmonary Disease Physician
SS036858
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0A110280
BCBS
MI
01
CG8207
RAIL ROAD MEDICARE
MI
Enumeration date
11/22/2006
Last updated
02/03/2016
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