NPIMap

Organization Active NPI

Lake Mi Mobile Doctors PC

  • Geriatric Medicine (Internal Medicine) Physician
  • San Antonio, TX
National Provider Identifier
1134472244
Registry record updated Oct 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
Legal business name
LAKE MI MOBILE DOCTORS PC
Practice address
3201 Cherry Ridge St
Suite C-315
San Antonio, TX 78230-4823
Phone
(210) 319-5487
Fax
(210) 342-2300
NPI assigned
Oct 26, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2012

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

Authorized official

Name
Mr. Tysyn Contreras
Title
Director of Quality Assurance
Phone
(773) 751-7200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0300X Primary
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X

Addresses

Primary practice location

3201 Cherry Ridge St
Suite C-315
San Antonio, TX 78230-4823

Mailing address

3319 N. Elston Ave.
Suite 200
Chicago, IL 60618-5811
Phone (773) 751-7200

Other names 1

  • Mobile Doctors of San Antonio Doing business as

National Provider Directory

National Provider Directory

Locations

3319 N Elston Ave
#200
Chicago, IL 60618
Phone (773) 751-7200

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1351209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351209600000",
    "number": "1134472244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3319 N. ELSTON AVE.",
            "address_2": "SUITE 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606185811",
            "telephone_number": "773-751-7200",
            "fax_number": "773-583-4401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 CHERRY RIDGE ST",
            "address_2": "SUITE C-315",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782304823",
            "telephone_number": "210-319-5487",
            "fax_number": "210-342-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MI MOBILE DOCTORS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-26",
        "last_updated": "2012-10-26",
        "status": "A",
        "authorized_official_last_name": "CONTRERAS",
        "authorized_official_first_name": "TYSYN",
        "authorized_official_title_or_position": "DIRECTOR OF QUALITY ASSURANCE",
        "authorized_official_telephone_number": "773-751-7200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mobile Doctors of San Antonio",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2012; 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.