Individual
MS. CAROL LYNN LIDSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1 FORD PL, SUITE 2E, DETROIT, MI 48202-3450
(313) 937-3049
Mailing address
3139 S WAYNE RD, WAYNE, MI 48184-1220
(734) 722-2722
(734) 722-7006
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601002244
MI
Other
Enumeration date
08/19/2010
Last updated
08/19/2010
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