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General NPI Number Information
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NPI Number | 1740589399
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Entity Type | Organization
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Legal Business Name | LAKESHORE MEDICAL CLINIC LTD
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Dates
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Enumeration Date | 03/22/2011
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | 5250 S 108TH ST
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City | HALES CORNERS
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State | WI
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Zip | 53130-1321
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Country | US
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Telephone | 414-525-2433
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Fax | 414-525-2421
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Provider Business Mailing Address
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Address Line | 5250 S 108TH ST
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City | HALES CORNERS
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State | WI
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Zip | 53130-1321
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Country | US
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Telephone | 414-525-2433
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Fax | 414-525-2421
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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 | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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