Lake Podiatry, PC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

5901002029 Issued in MI

Legal business name

LAKE PODIATRY, PC

Practice address

10570 Blue Star M Hwy
South Haven, MI 49090-8923

Phone

(269) 978-3385

Fax

(269) 978-2711

NPI assigned

Jun 26, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Raziuddin Ahmed, DPMNPI 1972506293

Title

President & Ceo

Phone

(818) 518-6768

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Raziuddin Ahmed, DPM

  • Podiatrist
  • South Haven, MI
  • NPI 1972506293
  NPD Authorized official
• Regina Lynne Spears, D.P.M.

  • Podiatrist
  • South Haven, MI
  • NPI 1568464501
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243555200000",
    "number": "1063449346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10570 BLUE STAR M HWY",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490908923",
            "telephone_number": "269-978-3385",
            "fax_number": "269-978-2711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10570 BLUE STAR M HWY",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490908923",
            "telephone_number": "269-978-3385",
            "fax_number": "269-978-2711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE PODIATRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2009-05-29",
        "status": "A",
        "authorized_official_last_name": "AHMED",
        "authorized_official_first_name": "RAZIUDDIN",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "818-518-6768",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MI",
            "license": "5901002029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4952336",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DF2298",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kai Steele Dentistry PLLC
• Lynneise Karadsheh
• Grace Ella Katt
• Mark Wells Kemp, DO
• Linda M Krzemen, RN
• Laura J. Lau, PHARM.D.
• Laurel Oaks of South Haven
• Frederick James Leavitt, DDS
• Lisa Marie Letts, LMT
• David Michael Liscow, M.D.

• Foot & Ankle Surgery Podiatrist in South Haven, MI
• Providers in South Haven, MI by specialty
• Foot & Ankle Surgery Podiatrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.