Provider Demographics
NPI:1124229489
Name:LAKESHORE FAMILY MEDICINE, P.C.
Entity Type:Organization
Organization Name:LAKESHORE FAMILY MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:
Authorized Official - Last Name:SATTERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-699-5982
Mailing Address - Street 1:6221 ROUTE 31
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039
Mailing Address - Country:US
Mailing Address - Phone:315-699-5982
Mailing Address - Fax:315-699-7221
Practice Address - Street 1:6221 RTE 31
Practice Address - Street 2:SUITE 108
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039
Practice Address - Country:US
Practice Address - Phone:315-699-5982
Practice Address - Fax:315-699-7221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0549Medicare ID - Type Unspecified