Lake Mi Mobile Doctors, P.C.

Primary specialty

Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X

Legal business name

LAKE MI MOBILE DOCTORS, P.C.

Doing business as

Mobile Doctors of Detroit Podiatry

Practice address

24445 Northwestern Hwy
Suite #206
Southfield, MI 48075-6501

Phone

(248) 799-0086

Fax

(248) 350-1178

NPI assigned

Nov 7, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Tysyn Contreras

Title

Director, Quality Assurance

Phone

(773) 751-7200

Specialties & licenses 1

Addresses

Other names 1

• Mobile Doctors of Detroit Podiatry Doing business as

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349740800000",
    "number": "1205905916",
    "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": "24445 NORTHWESTERN HWY",
            "address_2": "SUITE #206",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480756501",
            "telephone_number": "248-799-0086",
            "fax_number": "248-350-1178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MI MOBILE DOCTORS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2012-10-09",
        "status": "A",
        "authorized_official_last_name": "CONTRERAS",
        "authorized_official_first_name": "TYSYN",
        "authorized_official_title_or_position": "DIRECTOR, QUALITY ASSURANCE",
        "authorized_official_telephone_number": "773-751-7200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mobile Doctors of Detroit Podiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Primary Podiatric Medicine Podiatrist in Southfield, MI
• Providers in Southfield, MI by specialty
• Primary Podiatric Medicine Podiatrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 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.