MEDICARE: T UGANDA LAWRENCE

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1730613399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	T UGANDA LAWRENCE

Provider Business Mailing Address
First Line	:	342 N WATER ST
Second Line	:	SUITE 617
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-5514
Country	:	US
Telephone Number	:	414-502-7212
Fax Number	:

Provider Business Practice Location Address
First Line	:	342 N WATER ST
Second Line	:	SUITE 617
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-5514
Country	:	US
Telephone Number	:	414-502-7212
Fax Number	:

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

Provider Enumeration Date	:	04/20/2017
Last Update Date	:	04/20/2017

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Directions to “ T UGANDA LAWRENCE ” Practice Location

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