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NPI Code Detail

MEDICARE: LAKESHORE MEDICAL CLINIC, LTD

MEDICARE: LAKESHORE MEDICAL CLINIC, 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
1332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1982809372
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKESHORE MEDICAL CLINIC, LTD
Provider Business Mailing Address
First Line : 5818 W CAPITOL DR
Second Line :
City : MILWAUKEE
State : WI
Zip : 53216-2247
Country : US
Telephone Number : 414-449-2114
Fax Number :
Provider Business Practice Location Address
First Line : 5818 W CAPITOL DR
Second Line :
City : MILWAUKEE
State : WI
Zip : 53216-2247
Country : US
Telephone Number : 414-449-2114
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MASOOD WASIULLAH
Credential : MD
Telephone Number : 414-744-6589
Provider Enumeration Date : 06/18/2007
Last Update Date : 08/22/2020

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Directions to “LAKESHORE MEDICAL CLINIC, LTD ” Practice Location

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