Organization
LAKESIDE URGENT CARE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TABATHA LEANNE STAGE (BILLING MANAGER)
(248) 853-2009
Entity
Organization
Contact information
Practice address
44472 HAYES RD, CLINTON TOWNSHIP, MI 48038-1090
(586) 412-0890
(586) 412-1069
Mailing address
44472 HAYES RD, CLINTON TOWNSHIP, MI 48038-1090
(586) 412-0890
(586) 412-1069
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720159304
—
MI
01
—
700E001600
BLUE CARE NETWORK
MI
Enumeration date
12/10/2009
Last updated
12/10/2009
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