Lakeside Medical Associates a Medical Group, Inc.

NPI #1205002862 in Glendale, California

Provider Information

NPI Number: 1205002862
Entity Type: Organization
Organization Name: Lakeside Medical Associates a Medical Group, Inc.
Primary Specialty: Family Medicine
Enumeration Date: May 5, 2008
Last Updated: May 11, 2009

Practice Location

Address: 1510 S CENTRAL AVE
Address 2: SUITE 300
City: Glendale
State: California
ZIP Code: 91204-2500
Phone: (818) 254-1511

Authorized Official

Name: DR. KERRY WEINER, MD
Title: PRESIDENT
Phone: (818) 637-2000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X
Internal Medicine - Gastroenterology — Gastroenterology	207RG0100X
General Practice	208D00000X
Family Medicine	207Q00000X	Primary

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