Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Lakeside Internal Medicine PC

Organization Primary Care Clinic/Center · NPI 1386840502

Lakeside Internal Medicine PC is a Primary Care Clinic/Center in Saint Clair Shores, Michigan. Licensed in Michigan. Registered with an NPI since 2007.

Licensed in
MI
In the registry since
2007
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

21519 Harper Ave Ste 109
Saint Clair Shores, MI 48080-2209
Phone: (586) 945-5012
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Primary Care Clinic/Center (primary) Taxonomy 261QP2300X · Licence 4301058249 (MI)

Record details

NPI number1386840502
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Paul Antony — President · (586) 778-5287
NPI enumeratedJune 25, 2007
Last updated in NPPESAugust 18, 2014
Mailing address21519 Harper Ave, Suite 109, Saint Clair Shores, MI 48080-2220

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