| Organization Name: | LAKESIDE MEDICAL CARE |
| NPI Number: | 1215307657 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TROY SASSE (PHYSICIAN) |
| Mailing Address: | 8746 Erie Rd Suite A Angola |
| State: | NY US |
| Postal Code: | 140069620 |
| Phone Number: | 7165494999 |
| Fax Number: | 7165494998 |
| NPI Enumeration Date: | 09/28/2015 |
| NPI Last Update Date: | 09/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | 266476-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |