| Lakeside Neurology P C | |
|
28573 Schoenherr Rd Warren MI 48088-4330 | |
| (586) 777-3375 | |
| (586) 777-3380 |
| Full Name | Lakeside Neurology P C |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 28573 Schoenherr Rd, Warren, Michigan |
| Authorized Official Name and Position | Tracey Martin (PRACTICE MANAGER) |
| Authorized Official Contact | 5867773375 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Neurology P C 28573 Schoenherr Rd Warren MI 48088-4330 Ph: (586) 777-3375 | Lakeside Neurology P C 28573 Schoenherr Rd Warren MI 48088-4330 Ph: (586) 777-3375 |
| NPI Number | 1982725735 |
|---|---|
| Provider Enumeration Date | 04/02/2007 |
| Last Update Date | 03/28/2023 |
| Certification Date | 03/28/2023 |
| Medicare PECOS PAC ID | 0648233353 |
|---|---|
| Medicare Enrollment ID | O20041104000277 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982725735 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Alicia G Lumley |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1730283433 PECOS PAC ID: 0446216741 Enrollment ID: I20041208000789 |
| Provider Name | Shyam Sunder Moudgil |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1740390848 PECOS PAC ID: 3476716770 Enrollment ID: I20120524000335 |
| Provider Name | Joanna M Hernandez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548622251 PECOS PAC ID: 2264728583 Enrollment ID: I20160912002107 |
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