# LAKE ERIE PODIATRY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922164409
- **Authorized official:** DR. MICHAEL A RUIZ DPM (MANAGER)
- **Authorized official phone:** (814) 833-3668

## Contact information

- **Practice address:** 3910 CAUGHEY RD STE 130, ERIE, PA 16506
- **Practice address phone:** (814) 833-3668
- **Practice address fax:** (888) 329-6120
- **Mailing address:** 3910 CAUGHEY RD STE 130, ERIE, PA 16506-4097
- **Mailing address phone:** (814) 833-3668

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | SC004630L | PA | Yes |

## Other

- **Enumeration date:** 12/28/2006
- **Last updated:** 08/10/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0019415170002 | — | PA |
| 01 | — | 480035188 | MEDICARE RRB | PA |