Lakeshore Family Care, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LAKESHORE FAMILY CARE, PC

Practice address

72 Filer St
Manistee, MI 49660-2717

Phone

(231) 723-5600

Fax

(231) 723-1048

NPI assigned

Mar 8, 2007

Last updated

Oct 17, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Paul Joseph Antal, MDNPI 1295845469

Title

President

Phone

(231) 723-5600

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Lakeshore Family Care, PC

  • Family Medicine Physician
  • Arcadia, MI
  • NPI 1285924506

  O20040612000159

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Lakeshore Family Care, PC

  • Family Medicine Physician
  • Arcadia, MI
  • NPI 1285924506
  NPPES parent name

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Paul Joseph Antal, M.D.

  • Family Medicine Physician
  • Manistee, MI
  • NPI 1295845469
  Medicare reassignment Care Compare group NPD Authorized official
• Jacob R Deboni, FNP

  • Family Nurse Practitioner
  • Manistee, MI
  • NPI 1578036091
  Medicare reassignment Care Compare group NPD
• Katie J Dye, PA-C

  • Physician Assistant
  • Manistee, MI
  • NPI 1760700363
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192579200000",
    "number": "1356472872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72 FILER ST",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496602717",
            "telephone_number": "231-723-5600",
            "fax_number": "231-723-1048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 FILER ST",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496602717",
            "telephone_number": "231-723-5600",
            "fax_number": "231-723-1048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE FAMILY CARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2007-10-17",
        "status": "A",
        "authorized_official_last_name": "ANTAL",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-723-5600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3353612",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4612281",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Klaus Peter Kutschke, M.D.
• Laina Laarman
• Nichole Delaine Ladd
• Christa Laduke
• Julie Lafreniere
• Alexa Michelle Lakso, CHW
• Iva Lane
• William F Lange, MD
• Layne Godzina DDS PLLC (Honest Dental Solutions)
• Amy Lewis

• Family Medicine Physician in Manistee, MI
• Providers in Manistee, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.