Organization
LAKE ERIE PODIATRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL A RUIZ DPM (MANAGER)
(814) 833-3668
Entity
Organization
Contact information
Practice address
3910 CAUGHEY RD STE 130, ERIE, PA 16506
(814) 833-3668
(888) 329-6120
Mailing address
3910 CAUGHEY RD STE 130, ERIE, PA 16506-4097
(814) 833-3668
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
SC004630L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0019415170002
—
PA
01
—
480035188
MEDICARE RRB
PA
Enumeration date
12/28/2006
Last updated
08/10/2018
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