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General NPI Number Information
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NPI Number | 1285839662
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Entity Type | Organization
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Legal Business Name | LAKESHORE MEDICAL
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 06/29/2011
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Provider Practice Location Address
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Address Line | 9200 W LOOMIS RD STE 208
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City | FRANKLIN
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State | WI
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Zip | 53132-8887
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Country | US
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Telephone | 414-427-3280
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Fax |
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Provider Business Mailing Address
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Address Line | 100 15TH AVENUE SUITE 180
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City | SOUTH MILWAUKEE
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State | WI
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Zip | 53172
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Country | US
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Telephone | 414-427-3280
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MASOOD WASIULLAH
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Credential | MD
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Telephone | 414-744-6589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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