DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: EDWARD LAKE MD

MEDICARE: EDWARD LAKE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RN0300XNephrology Physician29465WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336131101
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD LAKE MD
Provider Business Mailing Address
First Line : PO BOX 735044
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5044
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 855 N WESTHAVEN DR
Second Line :
City : OSHKOSH
State : WI
Zip : 54904-7668
Country : US
Telephone Number : 920-303-5626
Fax Number : 920-303-5632
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2005
Last Update Date : 10/31/2023

Similar Medicare Providers

1821044892 — RYAN T ZANTOW MD
Practice Location Address:
855 N WESTHAVEN DR
OSHKOSH, WI
54904-7668
Practice Phone: 833-986-2170
Practice Fax:
1427054543 — DR. ERIN LEE KRUEGER AU.D.
Practice Location Address:
855 N WESTHAVEN DR , STE 200
OSHKOSH, WI
54904-7668
Practice Phone: 920-303-4130
Practice Fax: 920-303-4148
1538169214 — MR. STEPHEN G KENNEBECK PA-C
Practice Location Address:
855 N WESTHAVEN DR
OSHKOSH, WI
54904-7668
Practice Phone: 920-303-8700
Practice Fax:
1578563946 — DANIEL HAFNER PA
Practice Location Address:
855 N WESTHAVEN DR
OSHKOSH, WI
54904-7668
Practice Phone: 920-303-8700
Practice Fax:
1669474441 — STEVEN J HOOYMAN CRNA
Practice Location Address:
855 N WESTHAVEN DR
OSHKOSH, WI
54904-7668
Practice Phone: 920-303-8700
Practice Fax:
1124010749 — PHYLLIS LEE MD
Practice Location Address:
855 N WESTHAVEN DR
OSHKOSH, WI
54904-7668
Practice Phone: 920-303-8700
Practice Fax: 920-456-5901

Directions to “ EDWARD LAKE MD” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.