| NPI | 1043260490 |
|---|---|
| Other Name | LAKESHORE PEDIATRICS ANNEX |
| Entity Type | Organization |
| Authorized Contact | MICHAEL F GERVASI President & CEO 561-844-9443 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2011-09-06 |