LAKE SHORE PODIATRY CENTER, LLC (NPI# 1679670905) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679670905 |
| Entity Type | Organization |
| Organization Name | LAKE SHORE PODIATRY CENTER, LLC |
| Practice Address |
2143 W Wellington Ave Chicago IL 60618-8268 |
| Mailing Address |
9933 S Western Ave Suite 102 Chicago IL 60643-1810 |
| Practice Telephone | 7738712250 |
| Practice Fax Number | 7736970134 |
| Mailing Telephone | 7732333800 |
| Mailing Fax Number | 7732332513 |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2008-02-14 |
| Authorized Official Name | DR. FORTUNEE MASSUDA (MEDICAL DIRECTOR & CEO) |
| Authorized Official Telephone | 7732330590 |
| Authorized Official Credential | DPM |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
IL | Podiatric Medicine & Surgery Service Providers | |
| N | 213ES0131X |
Podiatrist Specialization: Foot Surgery |
IL | Podiatric Medicine & Surgery Service Providers | |
| N | 213EP1101X |
Podiatrist Specialization: Primary Podiatric Medicine |
IL | Podiatric Medicine & Surgery Service Providers | |
| N | 213EP0504X |
Podiatrist Specialization: Public Medicine |
IL | Podiatric Medicine & Surgery Service Providers | |
| Y | 213E00000X | Podiatrist | IL | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS | 216-22095 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366434706 | Lake Shore Podiatry Center, LLC | Podiatrist | 2511 N Kedzie Blvd, 2nd Floor, Chicago, IL 60647-2634 | 2005-08-22 |
| 1366548018 | Lake Shore Podiatry Center, LLC | Podiatrist | 4733 N Damen Ave, Chicago, IL 60625-1442 | 2006-09-16 |
| 1346232873 | Lake Shore Podiatry Center, LLC | Podiatrist | 3000 N Halsted St, Suite 621, Chicago, IL 60657-5188 | 2005-08-19 |
| Street Address |
2143 W WELLINGTON AVE |
| City | CHICAGO |
| State | IL |
| Zip Code | 60618-8268 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992276307 | Nicole Ruffolo | Acupuncturist | 2143 W Wellington Ave, Chicago, IL 60618-8268 | 2018-12-10 |
| 1225432297 | Yigazu Wellness Clinic S.c. | Internal Medicine | 2143 W Wellington Ave, Suite 100, Chicago, IL 60618-8268 | 2014-10-20 |
| 1851428445 | Mandie Martuzzo | Physical Therapist | 2143 W Wellington Ave, Chicago, IL 60618-8268 | 2007-02-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134741622 | Cvs Aoc Services, L.L.C. | Optometrist | 4051 North Lincoln, Store 8751, Chicago, IL 60618 | 2020-05-07 |
| 1699317404 | Joseph Thank Harmon | Registered Nurse | 5645 W Addison, Chicago, IL 60618 | 2019-10-14 |
| 1760952626 | Prep Performance Center, LLC | Clinic/Center | 4022 N Rockwell Street, Chicago, IL 60618 | 2018-12-04 |
| 1528540986 | Ruby Erdmann | Dietitian, Registered | 3126 N Kimball Ave. #3w, Chicago, IL 60618 | 2018-09-02 |
| 1962997064 | Living Roots Psychotherapy, LLC | Clinic/Center | 4310 N Spaulding Ave, Chicago, IL 60618 | 2018-06-30 |
| 1962920116 | Alif Muhammad | Counselor | 3819 W Cornelia Ave #2, Chicago, IL 60618 | 2017-09-07 |
| 1417471178 | Daniel Lee Mcmillan | Counselor | 3433 N. Ridgeway Ave, Apt G, Chicago, IL 60618 | 2017-08-03 |
| 1508380486 | Callie Weinberg | Social Worker | 2945 N Damen Ave, 1s, Chicago, IL 60618 | 2017-08-01 |
| 1275062697 | Melissa Ann Prest | Dietitian, Registered | 3258 W Warner Ave, Apt 2, Chicago, IL 60618 | 2017-06-08 |
| 1871951038 | Bionic Prosthetics and Orthotics Group LLC | Prosthetic/Orthotic Supplier | 4315 N. Lincoln Avenue, Chicago, IL 60618 | 2016-02-03 |
| Find all providers in zip 60618 | ||||
| Taxonomy Code | 213E00000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114533700 | Podiatric Management Systems LLC | Podiatrist | 537 W 31st St, Chicago, IL 60616-3294 | 2020-09-18 |
| 1679187090 | Podiatric Management Systems LLC | Podiatrist | 5600 W Addison St Lowr 2ll, Chicago, IL 60634-4499 | 2020-09-02 |
| 1932742848 | Foot and Ankle Care & Associates, Ltd | Podiatrist | 3320 W 63rd St, Chicago, IL 60629-3317 | 2019-10-23 |
| 1437622966 | Tomasz Szmyd Dpm, PC | Podiatrist | 1500 E 67th St, Chicago, IL 60637-4427 | 2019-01-08 |
| 1548746761 | Jeremy Marchand | Podiatrist | 2751 W Winona St Rm Ap457, Chicago, IL 60625-2508 | 2018-07-11 |
| 1770004814 | Andrew Alward | Podiatrist | 2027 W Division St # 180, Chicago, IL 60622-9024 | 2017-06-28 |
| 1043730625 | Mary Elizabeth Hickner | Podiatrist | 2751 W Winona St Apt 457, Chicago, IL 60625-2508 | 2017-06-23 |
| 1225489172 | Alison Dawn Traffanstedt Young | Podiatrist | 30 N Michigan Ave Ste 1129, Chicago, IL 60602-3478 | 2016-06-22 |
| 1922454131 | Mary Cobb | Podiatrist | 1428 E 69th St, Chicago, IL 60637-4804 | 2016-05-05 |
| 1407233760 | Aaron Raestas | Podiatrist | 730 S Dearborn St # T, Chicago, IL 60605-1838 | 2015-05-06 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.