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Organization
LAKE SHORE PODIATRY CENTER, LLC
Active
Organization
LAKE SHORE PODIATRY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FORTUNEE MASSUDA DPM (MEDICAL DIRECTOR & CEO)
(773) 233-3800
Entity
Organization
Contact information
Practice address
4733 N DAMEN AVE, CHICAGO, IL 60625-1442
(773) 871-2250
(773) 697-0134
Mailing address
9933 S WESTERN AVE, SUITE 102, CHICAGO, IL 60643-1810
(773) 233-3800
(773) 233-2513
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
—
IL
213EP0504X
Public Medicine Podiatrist
—
IL
213EP1101X
Primary Podiatric Medicine Podiatrist
—
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
IL
213ES0131X
Foot Surgery Podiatrist
—
IL
Other
Enumeration date
09/16/2006
Last updated
07/17/2008
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