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NPI Code Detail

MEDICARE: LAKE SHORE FOOT & ANKLE, PC

MEDICARE: LAKE SHORE FOOT & ANKLE, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0103XFoot & Ankle Surgery Podiatrist016004996IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DF0111OTHERILRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
21627920OTHERILBCBS

General Provider Information

NPI Number : 1932429222
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKE SHORE FOOT & ANKLE, PC
Provider Business Mailing Address
First Line : 2623 N HALSTED ST
Second Line :
City : CHICAGO
State : IL
Zip : 60614-2393
Country : US
Telephone Number : 773-477-3668
Fax Number : 773-871-1244
Provider Business Practice Location Address
First Line : 1847 OAK ST
Second Line :
City : NORTHFIELD
State : IL
Zip : 60093-3013
Country : US
Telephone Number : 847-433-4441
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. LEE R STEIN
Credential : DPM
Telephone Number : 847-433-4441
Provider Enumeration Date : 06/09/2010
Last Update Date : 02/23/2011

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Directions to “LAKE SHORE FOOT & ANKLE, PC ” Practice Location

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