Provider Demographics
NPI:1467745901
Name:LAKE REGION FOOT AND ANKLE LLC
Entity Type:Organization
Organization Name:LAKE REGION FOOT AND ANKLE LLC
Other - Org Name:LAKE REGION FOOT & ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILZA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:207-893-1989
Mailing Address - Street 1:5 ABBY RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062
Mailing Address - Country:US
Mailing Address - Phone:207-893-1989
Mailing Address - Fax:207-893-0190
Practice Address - Street 1:5 ABBY RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062
Practice Address - Country:US
Practice Address - Phone:207-893-1989
Practice Address - Fax:207-893-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0021854Medicare PIN