Healthcare Provider Details

I. General information

NPI: 1649183344
Provider Name (Legal Business Name): LAKESIDE FOOT AND ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 RICHARD RD STE 200
DYER IN
46311-1779
US

IV. Provider business mailing address

890 RICHARD RD STE 200
DYER IN
46311-1779
US

V. Phone/Fax

Practice location:
  • Phone: 630-935-5922
  • Fax:
Mailing address:
  • Phone: 630-935-5922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: HUZAIFA HAIDER
Title or Position: OWNER
Credential: DPM
Phone: 630-935-5922