Provider Demographics
NPI:1851557474
Name:DR. LOAN LAM
Entity Type:Organization
Organization Name:DR. LOAN LAM
Other - Org Name:COMPREHENSIVE FOOT AND ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOAN
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:239-793-4642
Mailing Address - Street 1:3123 AVIAMAR CIR APT 104
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34114-9640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8340 COLLIER BLVD STE 400
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-3626
Practice Address - Country:US
Practice Address - Phone:239-919-2990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-03
Last Update Date:2008-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3302213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty