Provider Demographics
NPI:1447469457
Name:NORTHLAKE INTERNAL MEDICINE
Entity type:Organization
Organization Name:NORTHLAKE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWEIFLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-263-7082
Mailing Address - Street 1:5150 HILL RD E
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-5100
Mailing Address - Country:US
Mailing Address - Phone:707-263-7082
Mailing Address - Fax:707-263-0816
Practice Address - Street 1:5150 HILL RD E
Practice Address - Street 2:SUITE B
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-5100
Practice Address - Country:US
Practice Address - Phone:707-263-7082
Practice Address - Fax:707-263-0816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZZZ18509Z207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGROO88800Medicaid
CAGROO88800Medicaid