Provider Demographics
NPI:1114973591
Name:MISHA LANZAT, D.P.M., INC.
Entity type:Organization
Organization Name:MISHA LANZAT, D.P.M., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANZAT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:323-268-2711
Mailing Address - Street 1:3743 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-1703
Mailing Address - Country:US
Mailing Address - Phone:323-268-2711
Mailing Address - Fax:323-268-9260
Practice Address - Street 1:3743 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-1703
Practice Address - Country:US
Practice Address - Phone:323-268-2711
Practice Address - Fax:323-268-9260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3726213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E37260Medicaid
CA480032782OtherRAILROAD MEDICARE
CA0766470001Medicare NSC
CA480032782OtherRAILROAD MEDICARE
CAE3726Medicare ID - Type UnspecifiedMEDICARE
CA000E37260Medicaid