| NPI | 1811295108 |
|---|---|
| Doing Business As | LAKESIDE PHYSICIAN GROUP |
| Entity Type | Organization |
| Authorized Contact | DARLA MCCALLISTER CFO 405-936-1554 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology |
| Enumeration Date | 2011-03-10 |
| Last Update Date | 2012-02-24 |