Healthcare Provider Details

I. General information

NPI: 1679531958
Provider Name (Legal Business Name): KIMBERLY A LAMACK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N MAYFAIR ROAD
WAUWATOSA WI
53226-4216
US

IV. Provider business mailing address

201 N MAYFAIR ROAD
WAUWATOSA WI
53226-4216
US

V. Phone/Fax

Practice location:
  • Phone: 414-771-8228
  • Fax: 414-256-2483
Mailing address:
  • Phone: 414-771-8228
  • Fax: 414-256-2483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number102571
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number49002
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number48723
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: