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:
Authorized official contact:
Name: Massuda, Fortunee Doctor of Podiatric Medicine (DPM)
Phone: (773) 342-5850
Health care specialties
| Specialty | Code | License # | 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 16 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1366434706 | NPPES |
| Illinois | Other | 216-22095 | BCBS |
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