MEDICARE: DR. MICHAEL J LASSER 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
1	207V00000X	Obstetrics & Gynecology Physician	35601	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	002000217M	OTHER	HUMANA

General Provider Information

NPI Number	:	1598716342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL J LASSER MD

Provider Business Mailing Address
First Line	:	11211 W LINCOLN AVE
Second Line	:	LINCOLN AVENUE CLINIC
City	:	WEST ALLIS
State	:	WI
Zip	:	53227-1035
Country	:	US
Telephone Number	:	414-456-5900
Fax Number	:	414-327-7639

Provider Business Practice Location Address
First Line	:	11211 W LINCOLN AVE
Second Line	:	LINCOLN AVENUE CLINIC
City	:	WEST ALLIS
State	:	WI
Zip	:	53227-1035
Country	:	US
Telephone Number	:	414-456-5900
Fax Number	:	414-327-7639

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	10/16/2012

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