Lakeside Pediatric & Adolescent Medicine, Pllc
NPI #1003975087 in Coeur D'alene, Idaho
Provider Information
- NPI Number
- 1003975087
- Entity Type
- Organization
- Organization Name
- Lakeside Pediatric & Adolescent Medicine, Pllc
- Primary Specialty
- Pediatrics - Adolescent Medicine
- Enumeration Date
- Dec 6, 2006
- Last Updated
- Jul 12, 2012
Practice Location
- Address
- 980 W IRONWOOD DR
- Address 2
- STE 302
- City
- Coeur D'alene
- State
- Idaho
- ZIP Code
- 83814-2601
- Phone
- (208) 292-5437
Authorized Official
- Name
- DIANA R VANHOOK
- Title
- OFFICE MANAGER
- Phone
- (208) 292-5437
Specialties & Taxonomy Codes
| Specialty |
|---|
| Pediatrics - Adolescent Medicine — Adolescent Medicine |
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