Healthcare Provider Details

I. General information

NPI: 1255339446
Provider Name (Legal Business Name): LAKE REGION FAMILY FOOT & ANKLE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 TANDBERG TRL
WINDHAM ME
04062-5100
US

IV. Provider business mailing address

211 TANDBERG TRL
WINDHAM ME
04062-5100
US

V. Phone/Fax

Practice location:
  • Phone: 207-893-1989
  • Fax: 207-893-0190
Mailing address:
  • Phone: 207-893-1989
  • Fax: 207-893-0190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD221
License Number StateME

VIII. Authorized Official

Name: DR. ROBBIN W FROST
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 207-893-1989