LAKE SHORE PODIATRY CENTER, LLC (NPI# 1366434706) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366434706 |
| Entity Type | Organization |
| Organization Name | LAKE SHORE PODIATRY CENTER, LLC |
| Practice Address |
2511 N Kedzie Blvd 2nd Floor Chicago IL 60647-2634 |
| Mailing Address |
9933 S Western Ave Suite 102 Chicago IL 60643-1810 |
| Practice Telephone | 7733425850 |
| Practice Fax Number | 7734897729 |
| Mailing Telephone | 7732333800 |
| Mailing Fax Number | 7732332513 |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2008-07-03 |
| Authorized Official Name | MRS. FORTUNEE MASSUDA (MEDICAL DIRECTOR/CEO) |
| Authorized Official Telephone | 7733425850 |
| Authorized Official Credential | DPM |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 213E00000X | Podiatrist | 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 | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
IL | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS | 216-22095 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679670905 | Lake Shore Podiatry Center, LLC | Podiatrist | 2143 W Wellington Ave, Chicago, IL 60618-8268 | 2006-09-20 |
| 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 |
2511 N KEDZIE BLVD 2ND FLOOR |
| City | CHICAGO |
| State | IL |
| Zip Code | 60647-2634 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881089662 | Laura Johnson | Family Medicine | 2511 N Kedzie Blvd, Chicago, IL 60647 | 2015-03-30 |
| 1578977062 | Andrea Michelle Feijoo | Family Medicine | 2511 N Kedzie Blvd, Chicago, IL 60647-2603 | 2014-06-12 |
| 1407143944 | Rosa Nelly Perez | Family Medicine | 2511 N Kedzie Blvd, Amg-logan Square, Chicago, IL 60647-2603 | 2011-07-05 |
| 1275761488 | Nichole Suzanne Lupei | Family Medicine | 2511 N Kedzie Blvd, Chicago, IL 60647-2603 | 2009-06-25 |
| 1558531442 | Gold Coast Podiatry Center, LLC | Podiatrist | 2511 N Kedzie Blvd, 2nd Floor, Chicago, IL 60647-2634 | 2008-03-06 |
| 1427233998 | County Medical Group Ltd Finley W Brown Jr Md | Family Medicine | 2511 N Kedzie Blvd, Chicago, IL 60647-2634 | 2008-01-03 |
| 1477600716 | Finley Webster Brown Jr. | Family Medicine | 2511 N Kedzie Blvd, Chicago, IL 60647-2634 | 2007-01-05 |
| 1740290030 | Maria Pulido | Family Medicine | 2511 N Kedzie Blvd, Chicago, IL 60647-2634 | 2006-08-09 |
| 1417977851 | Jorge Alberto Kurganoff | Internal Medicine | 2511 N Kedzie Blvd, Chicago, IL 60647-2634 | 2006-07-20 |
| 1649205063 | Emily Chacko | Internal Medicine | 2511 N Kedzie Blvd, Chicago, IL 60647-2634 | 2006-07-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164035879 | Scott Spine and Health LLC | Chiropractor | 2560 W. Armitage Ave, Unit C2, Chicago, IL 60647 | 2020-08-24 |
| 1003424458 | Emily Gleesing | Physical Therapist | 1923 N Western Ave, Chicago, IL 60647 | 2020-07-21 |
| 1699301358 | Marcella Guzman P.C. | Dentist | 3236 W. Fullerton Ave., Chicago, IL 60647 | 2020-03-13 |
| 1740772342 | Envision Unlimited | Case Management | 2646 N Washtenaw Ave # 3n, Chicago, IL 60647 | 2018-05-31 |
| 1992297535 | Envision Unlimited | Case Management | 2646 N Washtenaw Ave # 2n, Chicago, IL 60647 | 2018-05-30 |
| 1942704580 | Team Rehabilitation Il15, LLC | Physical Therapist | 1923 N Western Avenue, Chicago, IL 60647 | 2018-03-20 |
| 1023517331 | Chicago Medical Healthcare Group, S.c. | Family Medicine | 3648 W Armitage Avenue, Chicago, IL 60647 | 2018-02-02 |
| 1023537693 | Erin Frommeyer | Physician Assistant | 2228 W Dickens Avenue, Chicago, IL 60647 | 2017-09-15 |
| 1457872475 | Stefanie Paola Maurtua | Behavioral Analyst | 2448 West Bloomingdale Ave., Apt 2e, Chicago, IL 60647 | 2017-06-29 |
| 1700322922 | Lumen Optical Illinois 4, LLC | Optometrist | 2420 N Elston, Bucktown, IL 60647 | 2017-01-11 |
| Find all providers in zip 60647 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821631367 | Dr Christine Heck PC | Podiatrist | 111 N Wabash Ave Ste 1914, Chicago, IL 60602-2968 | 2019-10-28 |
| 1013562578 | Bishoy Atef Botros | Podiatrist | 820 S Damen Ave Fl 7, Chicago, IL 60612-3728 | 2019-08-01 |
| 1346752656 | Prairie Foot & Ankle, P.C. | Podiatrist | 7447 West Talcott Ave, Suite 406, Chicago, IL 60163-3275 | 2017-10-26 |
| 1558886549 | Castle Podiatry, LLC | Podiatrist | 11628 S Western Ave, Chicago, IL 60643-4730 | 2017-08-10 |
| 1669854089 | Adam Shapiro | Podiatrist | 3710 N Pine Grove Ave, Chicago, IL 60613-4186 | 2015-06-22 |
| 1891103925 | Nathan Kramer | Podiatrist | 320 S Ashland Ave Ste 2, Chicago, IL 60607-2856 | 2014-08-01 |
| 1700292711 | Archer Foot Clinic | Podiatrist | 3113 S Archer Ave, Chicago, IL 60608-6223 | 2014-07-10 |
| 1871909382 | Rashad Sayeed | Podiatrist | 4646 N. Marine Drive, Chicago, IL 60640-0000 | 2014-07-03 |
| 1275964918 | Aleksandr Komarov Dpm LLC | Podiatrist | 1360 N Lake Shore Dr Apt 708, Chicago, IL 60610-8442 | 2013-12-05 |
| 1568895043 | Allison Rottman | Podiatrist | 4734 N Beacon St, 2w, Chicago, IL 60640-4847 | 2013-08-19 |
| 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.