Organization
LAKESIDE ORTHOPEDIC INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL EDWARD HEINER MD (PARTNER)
(928) 505-5555
Entity
Organization
Contact information
Practice address
25 RIVIERA BLVD, LAKE HAVASU CITY, AZ 86403-5694
(928) 505-5555
Mailing address
25 RIVIERA BLVD, LAKE HAVASU CITY, AZ 86403-5694
(928) 505-5555
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
225100000X
Physical Therapist
—
—
2471M1202X
Magnetic Resonance Imaging Radiologic Technologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DF0357
MEDICARE RAILROAD
AZ
Enumeration date
08/08/2007
Last updated
04/22/2026
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