Lake Side Surgical Associates Sc

NPI #1699779355 in Sturgeon Bay, Wisconsin

Provider Information

NPI Number: 1699779355
Entity Type: Organization
Organization Name: Lake Side Surgical Associates Sc
Primary Specialty: Specialist
Enumeration Date: Jun 10, 2005
Last Updated: Aug 22, 2020

Practice Location

Address: 1843 MICHIGAN ST
City: Sturgeon Bay
State: Wisconsin
ZIP Code: 54235-1007
Phone: (920) 746-1060

Authorized Official

Name: MR. MICHAEL T HERLACHE
Title: ADMINISTRATOR
Phone: (920) 746-1060

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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