Organization
LAKESIDE URGENT CARE, P. C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FADI DEMASHKIEH MD (OWNER)
(586) 412-0890
Entity
Organization
Contact information
Practice address
44472 HAYES RD, CLINTON TOWNSHIP, MI 48038-1090
(586) 412-0890
(586) 412-1065
Mailing address
44472 HAYES RD, CLINTON TOWNSHIP, MI 48038-1090
(586) 412-0890
(586) 412-1065
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
MI
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1106354161
BCBS OF MICHIGAN
MI
01
—
1720159304
COMMERCIAL
MI
05
—
1720159304
—
MI
01
—
700E001600
BCBS OF MICHIGAN
MI
01
—
700E001600
BLUE CARE NETWORK OF MICHIGAN
—
01
—
ON82490
HAP
MI
Enumeration date
11/13/2006
Last updated
07/28/2022
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