Healthcare Provider Details

I. General information

NPI: 1568474658
Provider Name (Legal Business Name): LAKESIDE DIABETES & ENDOCRINE CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 HOLLYWOOD RD SUITE 284
SAINT JOSEPH MI
49085-9151
US

IV. Provider business mailing address

3950 HOLLYWOOD RD SUITE 284
SAINT JOSEPH MI
49085-9151
US

V. Phone/Fax

Practice location:
  • Phone: 269-408-1600
  • Fax: 269-408-1602
Mailing address:
  • Phone: 269-408-1600
  • Fax: 269-408-1602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MAJDI S ALNAJJAR
Title or Position: PHYSICIAN/ OWNER
Credential: M.D.
Phone: 269-408-1600