Provider Demographics
NPI:1275564916
Name:LAKESIDE ORTHOPEDIC INSTITUTE LLC
Entity Type:Organization
Organization Name:LAKESIDE ORTHOPEDIC INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:BINDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-855-1444
Mailing Address - Street 1:1791 MESQUITE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5648
Mailing Address - Country:US
Mailing Address - Phone:928-855-1444
Mailing Address - Fax:
Practice Address - Street 1:1791 MESQUITE AVE
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5648
Practice Address - Country:US
Practice Address - Phone:928-855-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13802207X00000X
AZ23186207X00000X
AZ34564207X00000X
AZ26379207X00000X
207X00000X
AZ0554213ES0103X
AZ2641225100000X
AZ8192225100000X
AZ6762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDF0357OtherMEDICARE RAILROAD
AZDF0357OtherMEDICARE RAILROAD
AZZ110835Medicare PIN