Organization
LAKESIDE SURGERY, P.A.
Active
Other names
LAKESIDE SURGERY, P.A.
Organization subpart
No
Provider details
NPI number
Authorized official
KATHERINE R MAKOHON MD (SURGEON/OWNER)
(972) 722-3290
Entity
Organization
Contact information
Practice address
3142 HORIZON RD, SUITE 206, ROCKWALL, TX 75032-7809
(972) 722-3290
(469) 402-2585
Mailing address
2850 SHORELINE TRL, PMB 154, ROCKWALL, TX 75032-5508
(972) 772-3290
(469) 402-2585
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
J2983
TX
174400000X
Specialist
Primary
K6483
TX
174400000X
Specialist
P6593
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1326097676
NPI
TX
01
—
1952393415
NPI
TX
Enumeration date
10/10/2006
Last updated
06/07/2013
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