LAKESHORE MEDICAL CLINIC (NPI# 1205240686) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205240686 |
| Entity Type | Organization |
| Organization Name | LAKESHORE MEDICAL CLINIC |
| Practice Address |
3305 S 20th St Suite 100 Milwaukee WI 53215-4940 |
| Practice Telephone | 4146451808 |
| Mailing Telephone | 4146451808 |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2014-06-13 |
| Authorized Official Name | FRANK LAVORA (PODIATRIST) |
| Authorized Official Telephone | 4147685430 |
| Authorized Official Credential | DPM |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
178111-30 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861754244 | Lakeshore Medical Clinic | Occupational Therapist | 4444 West Loomis Road, 200, Greenfield, WI 53220 | 2012-06-12 |
| 1053748160 | Lakeshore Medical Clinic | Nurse Practitioner | 100 15th Ave, South Milwaukee, WI 53172-1160 | 2013-10-03 |
| 1629206230 | Lakeshore Medical Clinic | Durable Medical Equipment & Medical Supplies | 10520 N Port Washington Rd, Mequon, WI 53092-5537 | 2009-06-23 |
| Street Address |
3305 S 20TH ST SUITE 100 |
| City | MILWAUKEE |
| State | WI |
| Zip Code | 53215-4940 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922082312 | Navtej S Purewal | Anesthesiology | 3305 S 20th St, Suite 150, Milwaukee, WI 53215-4940 | 2005-11-30 |
| 1467923409 | Elizabeth M Ullig | Nurse Practitioner | 3305 S 20th St, Milwaukee, WI 53215-4940 | 2018-12-17 |
| 1902214612 | Ashley A Moriwaki | Nurse Practitioner | 3305 S 20th St, Ste 100, Milwaukee, WI 53215-4940 | 2014-07-25 |
| 1679831655 | Melissa Renee Nowicki | Nurse Practitioner | 3305 S 20th St, Milwaukee, WI 53215-4940 | 2012-04-27 |
| 1922397660 | Arslan Zaidi | Anesthesiology | 3305 S 20th St, Suite 100, Milwaukee, WI 53215-4940 | 2011-04-04 |
| 1720394463 | Kong Her | Physician Assistant | 3305 S 20th St, Milwaukee, WI 53215-4940 | 2010-08-19 |
| 1013220185 | Michael A. Didion D.o.,s.c. | Anesthesiology | 3305 S 20th St, Suite 150, Milwaukee, WI 53215-4940 | 2010-07-19 |
| 1508021593 | Ifeyinwa N Igwe | Internal Medicine | 3305 S 20th St, Milwaukee, WI 53215-4940 | 2008-07-19 |
| 1619154952 | Pritika Bhatia, M.d., LLC. | Pain Medicine | 3305 S 20th St, Ste 150, Milwaukee, WI 53215-4940 | 2008-01-29 |
| 1790980191 | Lakeshore Medical Clinic, LLC | Durable Medical Equipment & Medical Supplies | 3305 S 20th St, Milwaukee, WI 53215-4940 | 2007-06-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841829918 | Joshua Michael Brooks | Student in an Organized Health Care Education/Training Program | Aurora St. Lukes Medical Center 2901 W Oklahoma Ave, Milwaukee, WI 53215 | 2020-04-02 |
| 1053967091 | Kristina Strupp | Clinical Nurse Specialist | 2900 W. Oaklahoma Avenue, Milwaukee, WI 53215 | 2019-08-15 |
| 1427510296 | Madelyn Pickle | Student in an Organized Health Care Education/Training Program | 2801 W. Kinnickinnic Rd Ste 250, Milwaukee, WI 53215 | 2019-04-02 |
| 1932601838 | Elizabeth D Morawski | Nurse Practitioner | 2801 Kinnickinnic Parkway, Suite 630, Milwaukee, WI 53215 | 2018-03-06 |
| 1457872673 | Canzata Kimberly Dent | Counselor | 2727 W. Cleveland Suite 204, Milwaukee, WI 53215 | 2017-06-28 |
| 1538689955 | Christian Pena | Durable Medical Equipment & Medical Supplies | 2800 W Forest Home Ave, Suite 100, Milwaukee, WI 53215 | 2017-06-27 |
| 1386178804 | Dane A Olsen | Family Medicine | 801 W Kinnickinnic River Pkwy., Suite 250, Milwaukee, WI 53215 | 2017-04-12 |
| 1811443492 | Thomas Diamond | Physical Therapist | 2901 Kinnickinnic Parkway, Milwaukee, WI 53215 | 2016-09-01 |
| 1487055133 | Sam Khalili | Otolaryngology | 2801 W Kinnickinnic River Pkwy # 680, Milwaukee, WI 53215 | 2014-09-12 |
| 1992105621 | Nicole R Hall | Nurse Practitioner | 2901 S Kinnickinnic Ave, Milwaukee, WI 53215 | 2014-08-29 |
| Find all providers in zip 53215 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982203857 | Tiera Manuel | Nurse Practitioner | 3956 N 28th St, Milwaukee, WI 53216-2637 | 2020-10-22 |
| 1801494778 | Tajana Jovicic | Nurse Practitioner | 3157 S 66th St, Milwaukee, WI 53219-4105 | 2020-10-13 |
| 1093320459 | Tyronda T Gray | Nurse Practitioner | 5833 N 117th St, Milwaukee, WI 53225-2207 | 2020-09-12 |
| 1861005837 | Clair Roser Rivera | Nurse Practitioner | 3734 W Ohio Ave, Milwaukee, WI 53215-4047 | 2020-08-28 |
| 1760003909 | Mary Esson | Nurse Practitioner | 100 N 75th St, Milwaukee, WI 53213-3516 | 2020-04-28 |
| 1487297271 | Mackenna Leslie Hill | Nurse Practitioner | 11002 W Park Pl, Milwaukee, WI 53224-3615 | 2019-10-24 |
| 1093276040 | Danielle L Laczniak | Nurse Practitioner | 3070 N 51st St Fl 6, Milwaukee, WI 53210-1645 | 2019-03-30 |
| 1871066506 | Lisa Ann Parker | Nurse Practitioner | 3237 S 16th St # 208, Milwaukee, WI 53215-4526 | 2019-01-04 |
| 1467922948 | Gretchen Louise Grencer-liegel | Nurse Practitioner | 1555 N Rivercenter Dr Ste 205, Milwaukee, WI 53212-3958 | 2018-11-28 |
| 1871074385 | Mary Teresa Falk | Nurse Practitioner | 2350 N Lake Dr Ste 306, Milwaukee, WI 53211-4528 | 2018-08-23 |
| Find all providers in MILWAUKEE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.