Organization
LAKE PODIATRY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAZIUDDIN AHMED DPM (PRESIDENT & CEO)
(818) 518-6768
Entity
Organization
Contact information
Practice address
10570 BLUE STAR M HWY, SOUTH HAVEN, MI 49090-8923
(269) 978-3385
(269) 978-2711
Mailing address
10570 BLUE STAR M HWY, SOUTH HAVEN, MI 49090-8923
(269) 978-3385
(269) 978-2711
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
5901002029
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4952336
—
MI
01
—
DF2298
RAILROAD MEDICARE
MI
Enumeration date
06/26/2006
Last updated
05/29/2009
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