Healthcare Provider Details

I. General information

NPI: 1578583621
Provider Name (Legal Business Name): JOSEPH LAMB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 MILL ST
NEW LONDON WI
54961-2155
US

IV. Provider business mailing address

122 E COLLEGE AVE
APPLETON WI
54911-5741
US

V. Phone/Fax

Practice location:
  • Phone: 920-531-2400
  • Fax: 920-531-2450
Mailing address:
  • Phone: 920-996-3264
  • Fax: 920-830-5970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29466
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: