Healthcare Provider Details

I. General information

NPI: 1659343754
Provider Name (Legal Business Name): JOHN S LANHAM DPM & ASSOCIATES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5720 W OKLAHOMA AVE
MILWAUKEE WI
53219-4301
US

IV. Provider business mailing address

5720 W OKLAHOMA AVENUE
MIILWAUKEE WI
53219
US

V. Phone/Fax

Practice location:
  • Phone: 414-541-5566
  • Fax: 414-541-6022
Mailing address:
  • Phone: 414-541-5566
  • Fax: 414-541-6022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number750
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN STUART LANHAM
Title or Position: PODIATRIST
Credential: DPM
Phone: 414-541-5566