| NPI | 1356099790 |
|---|---|
| Doing Business As | LAKESIDE PRIMARY CARE |
| Entity Type | Organization |
| Authorized Contact | DANIEL EDWARD HEINER Authorized Official 928-505-5555 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2022-03-15 |
| Last Update Date | 2024-09-12 |