National Provider Identifier Database

LAKESIDE PEDIATRIC ADOLESCENT MEDICINE PLLC
Adolescent Medicine

A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.


Contact Information

LAKESIDE PEDIATRIC & ADOLESCENT MEDICINE, PLLC
980 W IRONWOOD DR
STE 302
COEUR D'ALENE, ID83814-2601
Phone: 208-292-5437
Fax: 208-292-5441
Website:
Specialty Taxonomy Code
* Adolescent Medicine 2080A0000X

* Indicates primary specialty

NPI Profile & details for LAKESIDE PEDIATRIC & ADOLESCENT MEDICINE, PLLC

NPI Number 1003975087
Legal business name
LBN
LAKESIDE PEDIATRIC & ADOLESCENT MEDICINE, PLLC
Authorized official DIANA VANHOOK - (OFFICE MANAGER)
Entity Organization
Organization subpart No
Enumeration date 12/06/2006
Last updated 07/12/2012 - About 14 years ago
Sole proprietor1 Not specified
Identifiers
  • ID Medicaid: 806408200
  • ID Other: 4010138351 REGENCE BLUE SHIELD GROUP

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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