LAKESIDE MEDICAL GROUP PC NPI 1386769180

NPI Information

NPI: 1386769180
Provider Name: LAKESIDE MEDICAL GROUP, PC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
72 S WASHINGTON ST
SUITE 202
OXFORD, MI
ZIP 48371
Phone: (248) 628-0220
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LAKESIDE MEDICAL GROUP, PC is a family medicine in Oxford, MI. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. LAKESIDE MEDICAL GROUP, PC NPI is 1386769180. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

72 S WASHINGTON ST
SUITE 202
OXFORD, MI
ZIP 48371-973
Phone: (248) 628-0220
Fax: (248) 628-0226

The provider's authorized official is Steven L Hartz .
The authorized official title is President and has the following contact phone number (248) 628-0220.

The enumeration date for this NPI number is 3/20/2007 and was last updated on 6/30/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine		SH007361	MICHIGAN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0856300954	OTHER	MICHIGAN	BLUE CROSS BLUE SHIELD OF MICHIGAN
2	=========	OTHER	MICHIGAN	COMMERCIAL
3	291878311	MEDICAID	MICHIGAN
4	0M60200	MEDICARE PIN	MICHIGAN
5	207Q00000X	OTHER	MICHIGAN	TAXONOMY
6	0M60200001	MEDICARE PIN	MICHIGAN
7	E26740	MEDICARE UPIN	MICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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