MEDICARE: LAKESIDE INTEGRATIVE HEALTHCARE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1497549380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKESIDE INTEGRATIVE HEALTHCARE PC

Provider Business Mailing Address
First Line	:	11220 TREYNORTH DR STE A
Second Line	:
City	:	CORNELIUS
State	:	NC
Zip	:	28031-8198
Country	:	US
Telephone Number	:	704-896-8446
Fax Number	:	704-896-8495

Provider Business Practice Location Address
First Line	:	11220 TREYNORTH DR STE A
Second Line	:
City	:	CORNELIUS
State	:	NC
Zip	:	28031-8198
Country	:	US
Telephone Number	:	704-896-8446
Fax Number	:	704-896-8495

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KEVIN CORRIGAN
Credential	:	DO
Telephone Number	:	704-896-8446

Provider Enumeration Date	:	04/07/2025
Last Update Date	:	04/07/2025

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