OrganizationActive
Lakeside Internal Medicine PC
NPI 1386840502 · Primary Care Clinic/Center · Saint Clair Shores, MI
Provider details
- NPI number
- 1386840502
- Entity type
- Organization
- Primary specialty
- Primary Care Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Paul Antony, President(586) 778-5287
- License
- 4301058249 (MI)
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Detailed profile(89/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
21519 Harper Ave Ste 109
Saint Clair Shores, MI 48080-2209
Phone: (586) 945-5012
Street-level locationGet directions
Mailing address
21519 Harper Ave
Saint Clair Shores, MI 48080-2220
Registry dates
- Enumerated
- 2007-06-25
- Last updated
- 2014-08-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.