MEDICARE: LAKE PODIATRY, 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
1	213ES0103X	Foot & Ankle Surgery Podiatrist	5901002029	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DF2298	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063449346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE PODIATRY, PC

Provider Business Mailing Address
First Line	:	10570 BLUE STAR M HWY
Second Line	:
City	:	SOUTH HAVEN
State	:	MI
Zip	:	49090-8923
Country	:	US
Telephone Number	:	269-978-3385
Fax Number	:	269-978-2711

Provider Business Practice Location Address
First Line	:	10570 BLUE STAR M HWY
Second Line	:
City	:	SOUTH HAVEN
State	:	MI
Zip	:	49090-8923
Country	:	US
Telephone Number	:	269-978-3385
Fax Number	:	269-978-2711

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	RAZIUDDIN AHMED
Credential	:	DPM
Telephone Number	:	818-518-6768

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	05/29/2009

Similar Medicare Providers

1972506293 — RAZIUDDIN AHMED DPM
Practice Location Address:

10570 BLUE STAR M HWY
SOUTH HAVEN, MI
49090-8923

Practice Phone: 269-978-3385
Practice Fax: 269-978-2711

1568464501 — DR. REGINA LYNNE SPEARS D.P.M.
Practice Location Address:

10570 BLUE STAR M HWY
SOUTH HAVEN, MI
49090-8923

Practice Phone: 269-639-1115
Practice Fax: 269-639-2525

1326236514 — SOUTHWEST FAMILY FOOTCARE SPECIALIST, LLC
Practice Location Address:

10570 BLUE STAR M HWY
SOUTH HAVEN, MI
49090-8923

Practice Phone: 269-639-1115
Practice Fax: 269-639-2525

1053695874 — CHRISTINE SHORE MS
Practice Location Address:

256 CAPTAIN THOMAS BLVD APT 202
WEST HAVEN, CT
06516-8923

Practice Phone: 203-693-1550
Practice Fax:

1568684934 — LIFETIME DENTAL CARE OF INDIANA, PC
Practice Location Address:

8923 SOUTH MERIDIAN STREET , SUITE B
INDIANAPOLIS, IN
46217

Practice Phone: 317-887-4800
Practice Fax: 317-887-4801

1316941255 — EMMETT DEWAYNE COSGROVE OD
Practice Location Address:

11282 M140 HIGHWAY
SOUTH HAVEN, MI
49090-9405

Practice Phone: 269-637-1569
Practice Fax: 269-637-4519

Directions to “LAKE PODIATRY, PC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.