| Organization Name: | LAKE PODIATRY, PC |
| NPI Number: | 1063449346 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RAZIUDDIN AHMED (PRESIDENT & CEO) |
| Mailing Address: | 10570 Blue Star M Hwy South Haven |
| State: | MI US |
| Postal Code: | 490908923 |
| Phone Number: | 2699783385 |
| Fax Number: | 2699782711 |
| NPI Enumeration Date: | 06/26/2006 |
| NPI Last Update Date: | 05/29/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 5901002029 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |