| Lakeview Medical Center Pc | |
|
23600 Harper Ave Ste. 103 Saint Clair Shores MI 48080-1445 | |
| (586) 585-2570 | |
| (586) 585-2574 |
| Full Name | Lakeview Medical Center Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 23600 Harper Ave, Saint Clair Shores, Michigan |
| Authorized Official Name and Position | Magdy Wanis (OWNER) |
| Authorized Official Contact | 5865852570 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeview Medical Center Pc 23600 Harper Ave Ste. 103 Saint Clair Shores MI 48080-1445 Ph: (586) 585-2570 | Lakeview Medical Center Pc 23600 Harper Ave Ste. 103 Saint Clair Shores MI 48080-1445 Ph: (586) 585-2570 |
| NPI Number | 1285950162 |
|---|---|
| Provider Enumeration Date | 04/16/2010 |
| Last Update Date | 04/16/2010 |
| Medicare PECOS PAC ID | 0840482188 |
|---|---|
| Medicare Enrollment ID | O20101005001198 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285950162 | NPI | - | NPPES |
| 110500795-2 | Other | BCBS | |
| 4243830 | Medicaid | MI | |
| 912517500 | Other | MEDICAID FLORIDA | |
| P105025 | Other | BCN | |
| 127679 | Other | CARE CHOICES | |
| 21969 | Other | HEALTH PLAN OF MICHIGAN | |
| P00051536 | Other | MEDICARE RR | |
| 7189170 | Other | AETNA | |
| G89641 | Other | HAP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Magdy G Wanis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346353224 PECOS PAC ID: 4183816424 Enrollment ID: I20101005001243 |
| Provider Name | Mona Y Wissa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043971369 PECOS PAC ID: 3678967080 Enrollment ID: I20220301001853 |
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