Organization
LAKESIDE ORTHOPEDIC INSTITUTE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL EDWARD HEINER MD (AUTHORIZED OFFICIAL)
(928) 505-5555
Entity
Organization
Contact information
Practice address
2440 ADOBE RD STE 101, BULLHEAD CITY, AZ 86442-4486
(928) 505-5555
Mailing address
25 RIVIERA BLVD, LAKE HAVASU CITY, AZ 86403-5694
(928) 505-5555
(928) 555-5557
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
Other
Enumeration date
07/20/2022
Last updated
04/22/2026
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