Organization
LAKESIDE ORTHOPEDIC INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL EDWARD HEINER MD (MANAGING PARTNER)
(928) 505-5555
Entity
Organization
Contact information
Practice address
1791 MESQUITE AVE, LAKE HAVASU CITY, AZ 86403-5648
(928) 855-1444
Mailing address
1791 MESQUITE AVE, LAKE HAVASU CITY, AZ 86403-5648
(928) 855-4248
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
13802
AZ
207X00000X
Orthopaedic Surgery Physician
23186
AZ
207X00000X
Orthopaedic Surgery Physician
26379
AZ
207X00000X
Orthopaedic Surgery Physician
34564
AZ
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
0554
AZ
225100000X
Physical Therapist
2641
AZ
225100000X
Physical Therapist
6762
AZ
225100000X
Physical Therapist
8192
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DF0357
MEDICARE RAILROAD
AZ
Enumeration date
07/05/2006
Last updated
05/05/2026
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