Organization
LAKESIDE NEUROLOGY LLC
Active
Other names
Tin T. Win, M.D.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIN T WIN M.D. (OWNER)
(928) 680-8282
Entity
Organization
Contact information
Practice address
2180 MCCULLOCH BLVD N, LAKE HAVASU CITY, AZ 86403-6879
(928) 680-8282
(928) 680-8288
Mailing address
PO BOX 1440, LAKE HAVASU CITY, AZ 86405-1440
(928) 680-8282
(928) 680-8288
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
28212
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659357929
GROUP NPI NUMBER
AZ
Enumeration date
10/30/2007
Last updated
10/30/2007
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