1. Home
  2. Directory
  3. Michigan
  4. Saint Clair Shores
  5. Clinic Center
  6. NPI Profile

LAKESIDE INTERNAL MEDICINE PC
NPI 1386840502
Clinic/Center - Primary Care in Saint Clair Shores, MI

Active since June 25, 2007
21519 HARPER AVE STE 109, SAINT CLAIR SHORES, MI 48080(586) 945-5012 Get Directions Write a Review

NPPES record last updated: August 18, 2014. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Lakeside Internal Medicine Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKESIDE INTERNAL MEDICINE PC (NPI 1386840502) is a healthcare organization registered as a primary care in Saint Clair Shores, Michigan and active in the NPI registry since June 2007. The organization lists Paul Antony, President, as its authorized official.

NPPES Registry Identity

NPI1386840502
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameLAKESIDE INTERNAL MEDICINE PC
Location Address21519 HARPER AVE STE 109Saint Clair Shores, MI 48080-2209
Mailing Address21519 Harper Ave, Suite 109Saint Clair Shores, MI 48080-2220 · (586) 447-3017
Phone(586) 945-5012
Organization SubpartNo
Authorized OfficialPaul AntonyPresident · (586) 778-5287
Enumeration DateJune 25, 2007
Last NPPES UpdateAugust 18, 2014
✔ NPI 1386840502 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
License✔ Licensed in MI · 4301058249
21519 HARPER AVE STE 109, Saint Clair Shores, MI 48080
Open in Google Maps ↗

Other Identifiers 3

Medicaid5199450MI
Medicare PIN0M17390MI
Medicare UPING16772

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CHELSEA RUMOHR
Counselor (Mental Health)
21519 HARPER AVE STE 109
SAINT CLAIR SHORES, MI 48080
Macomb County (586) 612-7110
ANCHOR POINT THERAPY GROUP LLC
Counselor (Mental Health)
21519 HARPER AVE STE 109
SAINT CLAIR SHORES, MI 48080
Macomb County (586) 612-7110

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lakeside Internal Medicine PC's NPI number?

The NPI number for Lakeside Internal Medicine PC is 1386840502. It was assigned to this organization in the NPPES registry on June 25, 2007.

Where is Lakeside Internal Medicine PC located?

Lakeside Internal Medicine PC is located at 21519 Harper Ave Ste 109, Saint Clair Shores, MI 48080. The listed phone number is (586) 945-5012.

What is Lakeside Internal Medicine PC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

When was this NPI record last updated?

The NPPES record for Lakeside Internal Medicine PC was last updated on August 18, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.