Provider Demographics
NPI:1871797407
Name:WILLIAM J LEHRICH DPM INC
Entity type:Organization
Organization Name:WILLIAM J LEHRICH DPM INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-473-9655
Mailing Address - Street 1:PO BOX 1270
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-1270
Mailing Address - Country:US
Mailing Address - Phone:510-278-9350
Mailing Address - Fax:
Practice Address - Street 1:15035 E 14TH ST # A
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1901
Practice Address - Country:US
Practice Address - Phone:510-278-9350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE17380213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA480010688OtherMEDICARE RAILRAOD
CAGR0007941Medicaid
CAT11049Medicare UPIN
CA000E17383Medicare PIN
CAZZZ07598ZMedicare PIN
CA480010688OtherMEDICARE RAILRAOD
CAGR0007941Medicaid
CA0381140001Medicare NSC
CA000E17380Medicare PIN