Provider Demographics
NPI:1366711632
Name:THREE LAKES SURGICARE PLLC
Entity type:Organization
Organization Name:THREE LAKES SURGICARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PODIATRIC MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:H
Authorized Official - Last Name:THOMAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:512-328-8900
Mailing Address - Street 1:5000 BEE CAVE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5254
Mailing Address - Country:US
Mailing Address - Phone:512-328-8900
Mailing Address - Fax:
Practice Address - Street 1:5000 BEE CAVE RD STE 202
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5254
Practice Address - Country:US
Practice Address - Phone:512-328-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1720261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical