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General NPI Number Information
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NPI Number | 1861437493
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Entity Type | Organization
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Legal Business Name | LAKESIDE ORTHOPEDICS, PC.
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 05/31/2012
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Provider Practice Location Address
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Address Line | 16909 LAKESIDE HILLS CT SUITE 208
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City | OMAHA
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State | NE
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Zip | 68130-2318
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Country | US
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Telephone | 402-758-5690
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Fax |
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Provider Business Mailing Address
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Address Line | 16909 LAKESIDE HILLS CT SUITE 208
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City | OMAHA
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State | NE
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Zip | 68130-2318
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Country | US
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Telephone | 402-758-5690
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID CLOUGH
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Credential | MD
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Telephone | 402-758-5690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State | NE
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