LAKESIDE UROLOGY PC (NPI# 1770696171) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770696171 |
| Entity Type | Organization |
| Organization Name | LAKESIDE UROLOGY PC |
| Practice Address |
815 Saint Joseph Dr Saint Joseph MI 49085-2529 |
| Practice Telephone | 2699824272 |
| Practice Fax Number | 2699835920 |
| Mailing Telephone | 2699824272 |
| Mailing Fax Number | 2699835920 |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2009-12-16 |
| Authorized Official Name | PETER BRIDGES (PHYSICIAN/OFFICE MANAGER) |
| Authorized Official Telephone | 2699824272 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BCBS MI | 0A11030 | 01 |
| Street Address |
815 SAINT JOSEPH DR |
| City | SAINT JOSEPH |
| State | MI |
| Zip Code | 49085-2529 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518945286 | John E Bannow | Urology | 815 Saint Joseph Dr, Saint Joseph, MI 49085-2529 | 2006-01-04 |
| 1689205262 | Lauren M Farris | Physician Assistant | 815 Saint Joseph Dr, Saint Joseph, MI 49085-2529 | 2020-01-31 |
| 1720576929 | Cayla Ariel Dungey | Nurse Practitioner | 815 Saint Joseph Dr, Saint Joseph, MI 49085-2529 | 2018-04-24 |
| 1083152680 | Lyndsey Brown | Physician Assistant | 815 Saint Joseph Dr, Saint Joseph, MI 49085-2529 | 2017-02-03 |
| 1033546122 | David M Kraklau | Urology | 815 Saint Joseph Dr, Saint Joseph, MI 49085-2529 | 2013-10-03 |
| 1588941066 | Lakeland Medical Practices | Urology | 815 Saint Joseph Dr, Saint Joseph, MI 49085-2529 | 2011-11-10 |
| 1326138926 | Lindsey Arden Kerr | Urology | 815 Saint Joseph Dr, Saint Joseph, MI 49085-2529 | 2006-10-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134758949 | Ahmed Elshareif | Student in an Organized Health Care Education/Training Program | Lakeland Health, 1234 Napier Avenue, Saint Joseph, MI 49085 | 2020-04-03 |
| 1033747225 | Ezra Fox | Student in an Organized Health Care Education/Training Program | Lakeland Health- Gme, 1234 Napier Avenue, St. Joseph, MI 49085 | 2020-04-01 |
| 1679033930 | Asad Butt | Student in an Organized Health Care Education/Training Program | Lakeland Health-gme, 1234 Napier Avenue, Saint Joseph, MI 49085 | 2019-03-22 |
| 1184194714 | Benjamin Phillip Knuth | Physical Therapist | 3950 Hollywood Road, Suite 140, Saint Joseph, MI 49085 | 2018-11-27 |
| 1336624279 | Brandi Chatot | Counselor | 1101 Broad Street #8, Saint Joseph, MI 49085 | 2018-09-26 |
| 1396239562 | Lakeland Medical Practices | Family Medicine | 2500 Niles Ave., Suite 1, St. Joseph, MI 49085 | 2018-06-20 |
| 1760976518 | Premier Health Associates, Inc. | Home Health | 1111 Main Sr, St Joseph, MI 49085 | 2018-06-15 |
| 1053817783 | Chantell Strong | Student in an Organized Health Care Education/Training Program | Lakeland Health - Gme, 1234 Napier Avenue, Saint Joseph, MI 49085 | 2018-04-02 |
| 1386144053 | Anjana Gupta, Dds, Pllc | Dentist | 2800 Niles Road, Saint Joseph, MI 49085 | 2018-02-19 |
| 1356858997 | Hope Reborn Counseling, Pllc | Counselor | 2816 Willa Dr, Saint Joseph, MI 49085 | 2018-01-04 |
| Find all providers in zip 49085 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740497825 | Mobile Medical Services, Inc | Urology | 306 S Belt Hwy, Saint Joseph, MO 64506-3418 | 2007-05-17 |
| 1518945286 | John E Bannow | Urology | 815 Saint Joseph Dr, Saint Joseph, MI 49085-2529 | 2006-01-04 |
| 1033546122 | David M Kraklau | Urology | 815 Saint Joseph Dr, Saint Joseph, MI 49085-2529 | 2013-10-03 |
| 1588941066 | Lakeland Medical Practices | Urology | 815 Saint Joseph Dr, Saint Joseph, MI 49085-2529 | 2011-11-10 |
| 1528346178 | St. Joseph Urology, LLC | Urology | 711 N 36th St, Saint Joseph, MO 64506-2977 | 2011-08-01 |
| 1326138926 | Lindsey Arden Kerr | Urology | 815 Saint Joseph Dr, Saint Joseph, MI 49085-2529 | 2006-10-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609477488 | Munson Healthcare Charlevoix Hospital | Urology | 11695 Park Ave, Suite A, Charlevoix, MI 49720 | 2020-11-06 |
| 1396235610 | Munson Medical Center | Urology | 405 N Division Rd Ste 2, Petoskey, MI 49770-9046 | 2018-05-11 |
| 1770072498 | Bellin Health Iron Mountain Inc | Urology | 1005 S Hemlock St Ste B, Iron Mountain, MI 49801-3854 | 2018-05-08 |
| 1205215621 | Alexander David Tapper | Urology | 44200 Woodward Ave Ste 207, Pontiac, MI 48341-5045 | 2015-05-19 |
| 1912324211 | Boston Medical Group, P.C. | Urology | 24901 Northwestern Hwy., Suite 615, Southfield, MI 48075 | 2014-03-25 |
| 1548600984 | Katie Marie Rosen | Urology | 19991 Hall Rd Ste 201, Macomb, MI 48044 | 2013-06-30 |
| 1609213636 | Arya Khatiwoda | Urology | 2900 Hannah Blvd Ste 104, East Lansing, MI 48823-5380 | 2013-05-31 |
| 1003179730 | Kalen Jacob Rimar | Urology | 130 Town Center Dr Ste 101, Troy, MI 48084 | 2012-06-18 |
| 1780955294 | Harry Nicholas Kotsis | Urology | 265 Touraine Rd, Grosse Pointe Farms, MI 48236-3308 | 2012-01-16 |
| 1750678264 | Michael Kozminski | Urology | 245 Cherry St Se Ste 202, Grand Rapids, MI 49503-4607 | 2011-07-05 |
| Find all providers with the same taxonomy | ||||
| City | SAINT JOSEPH |
| Zip Code | 49085 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.