Lakeside Anesthesiology, S.c

NPI #1477897023 in Rockford, Illinois

Provider Information

NPI Number: 1477897023
Entity Type: Organization
Organization Name: Lakeside Anesthesiology, S.c
Subpart: Yes (part of a larger organization)
Parent Organization: LAKESIDE ANESTHESIOLOGY, S.C
Primary Specialty: Non-Pharmacy Dispensing Site
Enumeration Date: Nov 20, 2012
Last Updated: Nov 20, 2012

Practice Location

Address: 761 HIGHGROVE PL
City: Rockford
State: Illinois
ZIP Code: 61108-2520
Phone: (815) 209-2525

Authorized Official

Name: DR. DAVID S. FOOTERMAN, MD
Title: PRESIDENT
Phone: (815) 209-2525

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Non-Pharmacy Dispensing Site	332900000X	Primary

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