Lake Shore Podiatry Center, Llc

LBN: Lake Shore Podiatry Center, Llc
Lake Shore Podiatry Center, Llc is an health care organization with primary practice located at 2511 N Kedzie Blvd 2Nd Floor, Chicago IL 60647-2634. The organization recently has 5 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Podiatrist, Podiatric Medicine & Surgery Service Providers / Public Medicine, Podiatric Medicine & Surgery Service Providers / Primary Podiatric Medicine, Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, Podiatric Medicine & Surgery Service Providers / Foot Surgery. Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery is the primary health care specialty. Lake Shore Podiatry Center, Llc can be contacted via phone (773) 342-5850, or through Massuda, Fortunee via phone (773) 342-5850.

Contact Information

Primary practice address
2511 N Kedzie Blvd 2Nd Floor Chicago IL 60647-2634
Phone: (773) 342-5850
Fax: (773) 489-7729
Website:
Map and Directions
Authorized official contact:
Name: Massuda, Fortunee Doctor of Podiatric Medicine (DPM)
Phone: (773) 342-5850

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X Illinois
Podiatric Medicine & Surgery Service Providers / Public Medicine 213EP0504X Illinois
Podiatric Medicine & Surgery Service Providers / Primary Podiatric Medicine 213EP1101X Illinois
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X Illinois
Podiatric Medicine & Surgery Service Providers / Foot Surgery 213ES0131X Illinois

Profile Details

NPI number 1366434706
LBN Legal business name Lake Shore Podiatry Center, Llc
DBA Doing business as
Authorized official Massuda, Fortunee Doctor of Podiatric Medicine (DPM)
Entity Organization
Organization subpart 1 No
Enumeration date Aug 22nd, 2005
Last updated Jul 3rd, 2008 - about 18 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366434706 NPPES
Illinois Other 216-22095 BCBS

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