Lakeside Foot and Leg Care PLLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

Legal business name

LAKESIDE FOOT AND LEG CARE PLLC

Practice address

14322 Grandview Dr
Sterling Heights, MI 48313-3447

Phone

(248) 739-1379

NPI assigned

May 31, 2019

Last updated

Jan 23, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Siraj Panchbhaiya, DPM

Title

Owner

Phone

(248) 739-1379

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1559260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674432000000",
    "number": "1598323909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14322 GRANDVIEW DR",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483133447",
            "telephone_number": "248-739-1379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14322 GRANDVIEW DR",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483133447",
            "telephone_number": "248-739-1379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE FOOT AND LEG CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-31",
        "last_updated": "2023-01-23",
        "certification_date": "2023-01-23",
        "status": "A",
        "authorized_official_last_name": "PANCHBHAIYA",
        "authorized_official_first_name": "SIRAJ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-739-1379",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Foot & Ankle Surgery Podiatrist in Sterling Heights, MI
• Providers in Sterling Heights, 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 Jan 23, 2023; 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.