Lakeside Neurology P C

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

Legal business name

LAKESIDE NEUROLOGY P C

Practice address

28573 Schoenherr Rd
Warren, MI 48088-4330

Phone

(586) 777-3375

Fax

(586) 777-3380

NPI assigned

Apr 2, 2007

Last updated

Mar 28, 2023By 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

Tracey Martin

Title

Practice Manager

Phone

(586) 777-3375

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Interoperability endpoints

• Direct secure messaging: alumley26028@direct.beaumont.edu
• Direct secure messaging: smoudgil31234@direct.beaumont.edu

Practitioners 6

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.

• Joanna Hernandez, DNP, RN, AGACNP-BC

  • Gerontology Nurse Practitioner
  • Warren, MI
  • NPI 1548622251
  Medicare reassignment Care Compare group NPD
• Shyam Sunder Moudgil, MD

  • Neurology Physician
  • Roseville, MI
  • NPI 1740390848
  Medicare reassignment Care Compare group NPD
• Alicia G Lumley, MD

  • Neurology Physician
  • Roseville, MI
  • NPI 1730283433
  Medicare reassignment NPD
• Choon Soo Rim, MD

  • Neurology Physician
  • San Diego, CA
  • NPI 1083827273
  NPD
• Edward Alpert, MD

  • Allergy Physician
  • Warren, MI
  • NPI 1518932847
  NPD (past)
• Mark N Zacks, M.D.

  • Allergy & Immunology Physician
  • Brighton, MI
  • NPI 1881658953
  NPD (past)

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679961600000",
    "number": "1982725735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28573 SCHOENHERR RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480884330",
            "telephone_number": "586-777-3375",
            "fax_number": "586-777-3380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28573 SCHOENHERR RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480884330",
            "telephone_number": "586-777-3375",
            "fax_number": "586-777-3380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE NEUROLOGY P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "586-777-3375"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smoudgil31234@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "25195 Kelly Rd Ste B",
            "city": "Roseville",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480665084",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "alumley26028@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "25195 Kelly Rd Ste B",
            "city": "Roseville",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480665084",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Emi Laho
• Morgan Laird
• Laith Nafil MD PLLC
• Matthew R Lake
• Lakeshore Home Help - Agency LLC
• Ashley Lalone
• Carol Lambert, R.N.
• Megan Lambert, DC
• Wendy W Lambert, D.O.
• Dayna Lamkey

• Neurology Physician in Warren, MI
• Providers in Warren, MI by specialty
• Neurology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2023; 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.