Provider Demographics
NPI:1366739633
Name:XIAO, LINDSEY MICHELLE (DPM)
Entity type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:MICHELLE
Last Name:XIAO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:MICHELLE
Other - Last Name:GILLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:15 N DORADO CIR
Mailing Address - Street 2:APT 1D
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4612
Mailing Address - Country:US
Mailing Address - Phone:985-974-5911
Mailing Address - Fax:
Practice Address - Street 1:130 GIBBS POND RD
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-2255
Practice Address - Country:US
Practice Address - Phone:631-979-0060
Practice Address - Fax:631-724-4460
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006728213E00000X
MI5901002417213E00000X
LA308803213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5901002417OtherPODIATRY LICENSE
NYN006728OtherPODIATRY LICENSE
MI5315051542OtherCONTROLLED SUBSTANCE LICENSE
MI5315051542OtherCONTROLLED SUBSTANCE LICENSE