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1700192424
CAROL LYNN LIDSTROM
DETROIT, MI
NPI
1700192424
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363AM0700X Physician Assistant, Medical
(Licence: MI 5601002244)
Enumeration Date
2010-08-19
Last Update Date
2010-08-19
Business Address
Ms. CAROL LYNN LIDSTROM PA-C
1 FORD PL SUITE 2E
DETROIT, MI 48202-3450
Phone number: 313-937-3049
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Mailing Address
Ms. CAROL LYNN LIDSTROM PA-C
3139 S WAYNE RD
WAYNE, MI 48184-1220
Phone number: 734-722-2722
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