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General NPI Number Information
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NPI Number | 1518992536
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Entity Type | Organization
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Legal Business Name | LAKEVIEW PODIATRY ASSOC P C
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 10/17/2017
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Provider Practice Location Address
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Address Line | 22250 PROVIDENCE DR STE 100
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City | SOUTHFIELD
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State | MI
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Zip | 48075-6209
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Country | US
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Telephone | 248-424-8637
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Fax | 248-424-8663
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Provider Business Mailing Address
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Address Line | 22250 PROVIDENCE DR STE 100
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City | SOUTHFIELD
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State | MI
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Zip | 48075-6209
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Country | US
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Telephone | 248-424-8637
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Fax | 248-424-8663
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Authorized Official
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Title or Position | PHYSICIAN
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Name | GUY PUPP
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Credential | DPM
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Telephone | 248-424-8637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5901000690
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License Number State | MI
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