Provider Demographics
NPI:1497549380
Name:LAKESIDE INTEGRATIVE HEALTHCARE PC
Entity type:Organization
Organization Name:LAKESIDE INTEGRATIVE HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:704-896-8446
Mailing Address - Street 1:11220 TREYNORTH DR STE A
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8198
Mailing Address - Country:US
Mailing Address - Phone:704-896-8446
Mailing Address - Fax:704-896-8495
Practice Address - Street 1:11220 TREYNORTH DR STE A
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8198
Practice Address - Country:US
Practice Address - Phone:704-896-8446
Practice Address - Fax:704-896-8495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty