Provider Demographics
NPI:1013255207
Name:LAWRENCE PODIATRY CENTER LLC
Entity Type:Organization
Organization Name:LAWRENCE PODIATRY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:PILAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:785-843-0973
Mailing Address - Street 1:4102 W 6TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4626
Mailing Address - Country:US
Mailing Address - Phone:785-843-0973
Mailing Address - Fax:785-843-1839
Practice Address - Street 1:4102 W 6TH ST STE A
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4626
Practice Address - Country:US
Practice Address - Phone:785-843-0973
Practice Address - Fax:785-843-1839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1200392213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty