| NPI | 1932493863 |
|---|---|
| Doing Business As | LAKESIDE UROLOGY |
| Entity Type | Organization |
| Authorized Contact | JANCIE CROCKER Director, Practice Operations 268-687-1152 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MI 4301036136) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2012-07-13 |