Healthcare Provider Details

I. General information

NPI: 1659420883
Provider Name (Legal Business Name): LAKE AREA FOOT CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 OAK PARK BLVD 2ND FLOOR
LAKE CHARLES LA
70601-8991
US

IV. Provider business mailing address

PO BOX 2068
LAKE CHARLES LA
70602-2068
US

V. Phone/Fax

Practice location:
  • Phone: 337-479-2200
  • Fax: 337-479-2263
Mailing address:
  • Phone: 337-479-2200
  • Fax: 337-479-2263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPD110R
License Number StateLA

VIII. Authorized Official

Name: DR. ROBERT A ARANGO
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 337-479-2200