LAKE SHORE PODIATRY CENTER LLC NPI 1366548018

NPI Information

NPI: 1366548018
Provider Name: LAKE SHORE PODIATRY CENTER, LLC
Classification: Podiatrist - 213ES0103X
Entity Type: Organization

Specialization: Foot & Ankle Surgery

Address:
4733 N DAMEN AVE
CHICAGO, IL
ZIP 60625
Phone: (773) 871-2250
Get Directions

LAKE SHORE PODIATRY CENTER, LLC is a foot and ankle surgery podiatrist in Chicago, IL. LAKE SHORE PODIATRY CENTER, LLC NPI is 1366548018. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

4733 N DAMEN AVE
CHICAGO, IL
ZIP 60625-442
Phone: (773) 871-2250
Fax: (773) 697-0134

The provider's authorized official is Fortunee Massuda .
The authorized official title is Medical Director & Ceo and has the following contact phone number (773) 233-3800.

The enumeration date for this NPI number is 9/16/2006 and was last updated on 7/17/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License State	Primary
1	213E00000X	Podiatrist		ILLINOIS	No
2	213ES0131X	Podiatrist	Foot Surgery	ILLINOIS	No
3	213EP1101X	Podiatrist	Primary Podiatric Medicine	ILLINOIS	No
4	213EP0504X	Podiatrist	Public Medicine	ILLINOIS	No
5	213ES0103X	Podiatrist	Foot & Ankle Surgery	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1366548018	MEDICARE NSC	ILLINOIS
2	530120	MEDICARE ID-TYPE UNSPECIFIED	ILLINOIS	MEDICARE GROUP NUMBER
3	216-22095	OTHER	ILLINOIS	BCBS
4	CH2456	MEDICARE PIN	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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