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General NPI Number Information
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NPI Number | 1720159304
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Entity Type | Organization
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Legal Business Name | LAKESIDE URGENT CARE, P. C.
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 44472 HAYES RD
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-1090
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Country | US
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Telephone | 586-412-0890
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Fax | 586-412-1065
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Provider Business Mailing Address
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Address Line | 44472 HAYES RD
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-1090
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Country | US
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Telephone | 586-412-0890
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Fax | 586-412-1065
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Authorized Official
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Title or Position | OWNER
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Name | DR. FADI DEMASHKIEH
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Credential | MD
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Telephone | 586-412-0890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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