Healthcare Provider Details

I. General information

NPI: 1366346157
Provider Name (Legal Business Name): LAKEFRONT MEDICAL SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5439 DURAND AVE STE 100
MOUNT PLEASANT WI
53406-5058
US

IV. Provider business mailing address

5439 DURAND AVE STE 100
MOUNT PLEASANT WI
53406-5058
US

V. Phone/Fax

Practice location:
  • Phone: 262-898-9000
  • Fax: 262-898-3030
Mailing address:
  • Phone: 262-898-9000
  • Fax: 262-898-3030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JONATHAN SAIGH
Title or Position: CEO
Credential: DC
Phone: 262-898-9000