LAKE SHORE PODIATRY CENTER, LLC; NPI #1366548018

Contact Information

LAKE SHORE PODIATRY CENTER, LLC

4733 N DAMEN AVE
CHICAGO, IL 60625-1442

Phone: 773-871-2250
Fax: 773-697-0134
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Surgery, Foot & Ankle	213ES0103X	48	Podiatry
Podiatrist	213E00000X	48	Podiatry
Primary Podiatric Medicine	213EP1101X	48	Podiatry
Public Health	213EP0504X	48	Podiatry
Surgery, Foot	213ES0131X	48	Podiatry

Indicates primary specialty

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NPI Profile & details for LAKE SHORE PODIATRY CENTER, LLC

NPI # 1366548018

LBN Legal business name LAKE SHORE PODIATRY CENTER, LLC

Authorized official FORTUNEE MASSUDA - (MEDICAL DIRECTOR & CEO)

Entity Organization

Organization subpart ¹ No

Enumeration date 09/16/2006

Last updated 07/17/2008 - About 18 years ago

Identifiers

Other

216-22095

BCBS

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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