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General NPI Number Information
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NPI Number | 1891902458
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Entity Type | Organization
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Legal Business Name | LAKESIDE FAMILY PHYSICIANS PLLC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 390 E SUNSET WAY
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City | ISSAQUAH
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State | WA
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Zip | 98027-3441
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Country | US
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Telephone | 425-246-0225
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Fax | 425-395-0245
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Provider Business Mailing Address
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Address Line | 2623 W PUMPKIN RIDGE DR
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City | ANTHEM
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State | AZ
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Zip | 85086-3027
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Country | US
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Telephone | 425-369-1342
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Fax | 623-440-0501
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Authorized Official
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Title or Position | OWNER
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Name | SAMANTHA MAPLETHORPE
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Credential | MD
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Telephone | 425-369-1342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | WA
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