NPI 1003975087

Lakeside Pediatric & Adolescent Medicine, PLLC

Organisation Pediatric Adolescent Medicine Physician Coeur D'Alene, ID

Practice location

Address: 980 W Ironwood Dr STE 302, Coeur D'Alene, ID 83814-2601
Phone: (208) 292-5437
Fax: (208) 292-5441

Authorised official

Name: Diana R Vanhook
Title: Office Manager
Phone: (208) 292-5437

Registered specialties

Pediatric Adolescent Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 2080A0000X

Other Pediatrics providers in Idaho →

Registry record

NPI: 1003975087
Entity type: Organization
NPI issued: 6 Dec 2006
Record last updated: 12 Jul 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.