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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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