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Lakeshore Medical Clinic

NPI #1629206230 in Mequon, Wisconsin

Provider Information

NPI Number
1629206230
Entity Type
Organization
Organization Name
Lakeshore Medical Clinic
Primary Specialty
Durable Medical Equipment & Medical Supplies
Enumeration Date
Jun 23, 2009
Last Updated
Jun 23, 2009

Practice Location

Address
10520 N PORT WASHINGTON RD
City
Mequon
State
Wisconsin
ZIP Code
53092-5537
Phone
(262) 241-8000

Authorized Official

Name
MASOOD WASIULLAH, MD
Title
PRESIDENT
Phone
(262) 241-8000

Specialties & Taxonomy Codes

Specialty
Durable Medical Equipment & Medical Supplies

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