Lake Country Pediatrics Sc

NPI #1801849963 in Oconomowoc, Wisconsin

Provider Information

NPI Number: 1801849963
Entity Type: Organization
Organization Name: Lake Country Pediatrics Sc
Primary Specialty: Pediatrics
Enumeration Date: May 18, 2006
Last Updated: Aug 15, 2011

Practice Location

Address: 970 S SILVER LAKE ST
Address 2: STE. 102
City: Oconomowoc
State: Wisconsin
ZIP Code: 53066-3802
Phone: (262) 569-7100

Authorized Official

Name: DR. GREGORY M MOYER, M.D.
Title: DR.
Phone: (262) 569-7100

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pediatrics	208000000X	Primary

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