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NPI Code Detail

MEDICARE: LAKESHORE MEDICAL CLINIC, LLC

MEDICARE: LAKESHORE MEDICAL CLINIC, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1669646287
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKESHORE MEDICAL CLINIC, LLC
Provider Business Mailing Address
First Line : 2000 E LAYTON AVE
Second Line :
City : SAINT FRANCIS
State : WI
Zip : 53235-6053
Country : US
Telephone Number : 414-744-6589
Fax Number :
Provider Business Practice Location Address
First Line : 2000 E LAYTON AVE
Second Line :
City : SAINT FRANCIS
State : WI
Zip : 53235-6053
Country : US
Telephone Number : 414-744-6589
Fax Number :
Authorized Official
Title or Position : ASST TREASURER
Name : KARA RICHARDSON
Credential :
Telephone Number : 704-631-0450
Provider Enumeration Date : 04/15/2008
Last Update Date : 10/14/2025

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Directions to “LAKESHORE MEDICAL CLINIC, LLC ” Practice Location

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