Provider Demographics
NPI:1902159437
Name:LAKES AREA FOOT AND ANKLE CARE, PLLC
Entity Type:Organization
Organization Name:LAKES AREA FOOT AND ANKLE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:FEINMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-425-8124
Mailing Address - Street 1:PO BOX 1355
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-5355
Mailing Address - Country:US
Mailing Address - Phone:248-425-8124
Mailing Address - Fax:
Practice Address - Street 1:620 N PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-3448
Practice Address - Country:US
Practice Address - Phone:248-425-8124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315007043213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4856351900OtherBCBS
MI4350339-13Medicaid
MI0N39150Medicare PIN
MI4350339-13Medicaid