Lakeshore Kidney Care, PLLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

LAKESHORE KIDNEY CARE, PLLC

Practice address

4811 Venoy Rd
Wayne, MI 48184-2675

Phone

(734) 366-1361

Fax

(734) 366-1359

NPI assigned

Apr 3, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Mansur Khalid Pathan, DO

Title

Owner

Phone

(734) 366-1361

Specialties & licenses 1

Addresses

Practitioners 1

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

• Jawwad Rashid

  • Physical Therapist
  • Taylor, MI
  • NPI 1730566621
  NPD (past)

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

{
    "created_epoch": "1617408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617408000000",
    "number": "1932788346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46671 PINEHURST CIR",
            "city": "NORTHVILLE",
            "state": "MI",
            "postal_code": "481688488",
            "telephone_number": "734-366-1361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4811 VENOY RD",
            "city": "WAYNE",
            "state": "MI",
            "postal_code": "481842675",
            "telephone_number": "734-366-1361",
            "fax_number": "734-366-1359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE KIDNEY CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-03",
        "last_updated": "2021-04-03",
        "certification_date": "2021-03-16",
        "status": "A",
        "authorized_official_last_name": "PATHAN",
        "authorized_official_first_name": "MANSUR",
        "authorized_official_middle_name": "KHALID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-366-1361",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ravi Bhushan Kukkalli, P.T.
• Neelam B Kumar, MD
• Carol Kuyava, LBSW
• Christopher Lajeunesse, MD
• Sarah Lake, LLPC
• Derek Landry, OT
• Nishaya Shawnte Lang
• Tanya Lang
• Medgine Lautzenheiser
• Tyler Alise Le, MD

• Nephrology Physician in Wayne, MI
• Providers in Wayne, MI by specialty
• Nephrology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2021; 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.