Organization Active NPI

Lakeside Pulmonary Medicine PLLC

  • Pulmonary Disease Physician
  • Saint Joseph, MI
National Provider Identifier
1508707100
Registry record updated Apr 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
LAKESIDE PULMONARY MEDICINE PLLC
Practice address
435 Upton Dr
Saint Joseph, MI 49085-1058
Phone
(269) 588-1994
NPI assigned
Apr 6, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2026

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

Authorized official

Name
Dr. Cory M O'Brien, DO
Title
Owner
Phone
(517) 290-5639

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RP1001X Primary

Addresses

Primary practice location

435 Upton Dr
Saint Joseph, MI 49085-1058

Mailing address

435 Upton Dr
Saint Joseph, MI 49085-1058

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260520001556 MI Part B Supplier - Clinic/Group Practice 3678042520 Receives reassigned benefits from 1 practitioner
Practice locations: Saint Joseph, MI

National Provider Directory

National Provider Directory

Locations

435 Upton Dr
Saint Joseph, MI 49085
Phone (269) 588-1994

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1775433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775433600000",
    "number": "1508707100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 UPTON DR",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490851058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 UPTON DR",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490851058",
            "telephone_number": "269-588-1994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE PULMONARY MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-04-06",
        "last_updated": "2026-04-06",
        "certification_date": "2026-04-06",
        "status": "A",
        "authorized_official_last_name": "O'BRIEN",
        "authorized_official_first_name": "CORY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "517-290-5639",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Joseph, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.