Provider Demographics
NPI:1578646782
Name:LIGHTHOUSE FOOT AND ANKLE CENTER PC
Entity Type:Organization
Organization Name:LIGHTHOUSE FOOT AND ANKLE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:N
Authorized Official - Last Name:KURLANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:207-774-0028
Mailing Address - Street 1:23 SPRING ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7701
Mailing Address - Country:US
Mailing Address - Phone:207-774-0028
Mailing Address - Fax:207-774-0063
Practice Address - Street 1:23 SPRING ST
Practice Address - Street 2:SUITE B
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7701
Practice Address - Country:US
Practice Address - Phone:207-774-0028
Practice Address - Fax:207-774-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1047213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME7335092OtherAETNA
ME292820000Medicaid
MEU71993OtherHARVARD PILGRIM
ME048047OtherANTHEM
ME292820000Medicaid
ME7335092OtherAETNA
ME048047OtherANTHEM
MEU71993OtherHARVARD PILGRIM