Basic Information
| Provider Information | |||||||||
| NPI: | 1134322373 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAM | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | KWAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 661 GOODLETTE RD N | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341025609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394303668 | ||||||||
| FaxNumber: | 8667986785 | ||||||||
| Practice Location | |||||||||
| Address1: | 661 GOODLETTE RD N | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341025609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394303668 | ||||||||
| FaxNumber: | 8667986785 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2007 | ||||||||
| LastUpdateDate: | 07/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | PO3169 | FL | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213ES0103X | PO3169 | FL | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 65898 | 01 | FL | BCBS FLORIDA | OTHER | 65898Z | 01 | FL | MEDICARE | OTHER |