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General NPI Number Information
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NPI Number | 1710512819
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Entity Type | Organization
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Legal Business Name | LKW HEALTH LLC
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Dates
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Enumeration Date | 03/09/2020
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Last Update Date | 03/09/2020
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Provider Practice Location Address
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Address Line | 106 N WISCONSIN ST
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City | DE PERE
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State | WI
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Zip | 54115-2733
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Country | US
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Telephone | 920-327-7056
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Fax | 920-425-4955
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Provider Business Mailing Address
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Address Line | 106 N WISCONSIN ST
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City | DE PERE
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State | WI
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Zip | 54115-2733
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Country | US
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Telephone | 920-327-7056
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Fax | 920-425-4955
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | KASI STANKEVICH
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Credential |
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Telephone | 920-632-7158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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