MEDICARE: LAKE COUNTRY CARDIOVASCULAR ASSOCIATES LTD

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	207RC0000X	Cardiovascular Disease Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1831180371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE COUNTRY CARDIOVASCULAR ASSOCIATES LTD

Provider Business Mailing Address
First Line	:	6400 INDUSTRIAL LOOP
Second Line	:
City	:	GREENDALE
State	:	WI
Zip	:	53129-2452
Country	:	US
Telephone Number	:	414-423-4100
Fax Number	:	414-423-4134

Provider Business Practice Location Address
First Line	:	385 WILLIAMSTOWNE
Second Line	:
City	:	DELAFIELD
State	:	WI
Zip	:	53018-2323
Country	:	US
Telephone Number	:	262-646-3058
Fax Number	:	262-646-3002

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTOPHER J OSTROMECKI
Credential	:	M.D.
Telephone Number	:	262-646-3058

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	09/30/2011

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