Lakeside Neurology LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

28212 Issued in AZ

Legal business name

LAKESIDE NEUROLOGY LLC

Practice address

2180 McCulloch Blvd N
Lake Havasu City, AZ 86403-6879

Phone

(928) 680-8282

Fax

(928) 680-8288

NPI assigned

Oct 30, 2007

Last updated

Oct 30, 2007By 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

Dr. Tin T Win, M.D.NPI 1659357929

Title

Owner

Phone

(928) 680-8282

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Tin T. Win, M.D. Other name

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tin T Win, M.D.

  • Specialist
  • Lake Havasu City, AZ
  • NPI 1659357929
  NPD (past) Authorized official
• Julius Ray Charlie, M.D.

  • Neurology Physician
  • Mesa, AZ
  • NPI 1063479707
  NPD (past)

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

{
    "created_epoch": "1193702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193702400000",
    "number": "1609055276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1440",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864051440",
            "telephone_number": "928-680-8282",
            "fax_number": "928-680-8288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2180 MCCULLOCH BLVD N",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036879",
            "telephone_number": "928-680-8282",
            "fax_number": "928-680-8288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE NEUROLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-30",
        "last_updated": "2007-10-30",
        "status": "A",
        "authorized_official_last_name": "WIN",
        "authorized_official_first_name": "TIN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-680-8282",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "AZ",
            "license": "28212",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI NUMBER",
            "identifier": "1659357929",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tin T. Win, M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Lake Havasu Unified School Distrct
• Lake Havasu Unified School District #1
• Lake View Terrace Management LLC
• Lake View Terrace Memory Care (LHC Partners LP)
• Lakeside Heart and Vascular Center PLLC
• Lakeside Orthopedic Institute LLC
• Lakeside Orthopedic Institute LLC (Lakeside CT)
• Lakeside Orthopedic Institute LLC (Lakeside Mobile Imaging)
• Lakeside Orthopedic Institute LLC
• Lakeside Orthopedic Institute LLC

• Specialist in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Specialist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2007; 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.