Organization
LAKESIDE ORTHOPEDICS, PC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID CLOUGH MD (PRESIDENT)
(402) 758-5690
Entity
Organization
Contact information
Practice address
16909 LAKESIDE HILLS CT, SUITE 208, OMAHA, NE 68130-2318
(402) 758-5690
Mailing address
16909 LAKESIDE HILLS CT, SUITE 208, OMAHA, NE 68130-2318
(402) 758-5690
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0733162
—
IA
05
—
10025437200
—
NE
01
—
DF1449
RAILROAD MEDICARE
NE
Enumeration date
06/18/2006
Last updated
05/31/2012
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