Organization
LAKESIDE UROLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER BRIDGES MD (PHYSICIAN/OFFICE MANAGER)
(269) 982-4272
Entity
Organization
Contact information
Practice address
815 SAINT JOSEPH DR, SAINT JOSEPH, MI 49085-2529
(269) 982-4272
(269) 983-5920
Mailing address
815 SAINT JOSEPH DR, SAINT JOSEPH, MI 49085-2529
(269) 982-4272
(269) 983-5920
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0A11030
BCBS MI
MI
Enumeration date
08/17/2006
Last updated
12/16/2009
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