Organization Name: | LAKESHORE BONE & JOINT INSTITUTE, INC |
NPI Number: | 1104090893 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | THOMAS H KAY (PRESIDENT) |
Mailing Address: | 1550 S Woodland Ave Michigan City |
State: | IN US |
Postal Code: | 463607125 |
Phone Number: | 2199211444 |
Fax Number: | 2199215303 |
NPI Enumeration Date: | 04/15/2008 |
NPI Last Update Date: | 12/03/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |