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Organization
LAKESIDE FOOT CLINIC, PC
Active
Organization
LAKESIDE FOOT CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN MICHAEL SHIMKO DPM (SOLE PROPRIETOR)
(704) 892-3399
Entity
Organization
Contact information
Practice address
19453 W CATAWBA AVE STE A, CORNELIUS, NC 28031-4022
(704) 892-3399
(704) 892-5113
Mailing address
19453 W CATAWBA AVE STE A, CORNELIUS, NC 28031-4022
(704) 892-3399
(704) 892-5113
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
270
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0816H
BLUE CROSS BLUE SHIELD
NC
05
—
890816H
—
NC
Enumeration date
06/17/2008
Last updated
03/23/2015
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