LAKESIDE NEUROCARE LIMITED. (NPI# 1225220254) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225220254 |
| Entity Type | Organization |
| Organization Name | LAKESIDE NEUROCARE LIMITED. |
| Practice Address |
430 E Division St Fond Du Lac WI 54935-4560 |
| Mailing Address |
2700 W 9th Ave Ste 225 Oshkosh WI 54904-7865 |
| Practice Telephone | 9209235526 |
| Practice Fax Number | 9209235871 |
| Mailing Telephone | 9202235580 |
| Mailing Fax Number | 9202235592 |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2012-04-13 |
| Authorized Official Name | MRS. SUSAN M GOLDEN (BUSINESS MANAGER) |
| Authorized Official Telephone | 9202235582 |
| Authorized Official Credential | CPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 32820600 | 05 |
| Street Address |
430 E DIVISION ST |
| City | FOND DU LAC |
| State | WI |
| Zip Code | 54935-4560 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437157831 | Gilberto Cantu | Nurse Anesthetist, Certified Registered | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2005-07-09 |
| 1992306310 | Leah Timm | Nurse Practitioner | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2020-11-03 |
| 1982212312 | Tiffany M Parker | Counselor | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2020-07-22 |
| 1619594355 | Brynn Sytsma | Student in an Organized Health Care Education/Training Program | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2020-06-29 |
| 1891312633 | Joshua Mckinney | Counselor | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2020-06-27 |
| 1275153264 | Jacalyn Lucille Wendt Coleman | Dietitian, Registered | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2020-04-20 |
| 1568090884 | Jaclyn R Monteverde | Physician Assistant | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2020-03-31 |
| 1235766718 | Emily Jean Thiel | Dietitian, Registered | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2020-03-25 |
| 1326674136 | Alexandria Lynn Hefter | Nurse Practitioner | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2020-03-13 |
| 1952933046 | Gina Paveglio | Registered Nurse | 430 E Division St, Surgery Dept, Fond Du Lac, WI 54935 | 2020-02-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609482249 | Keziah Sherri Love | Counselor | W390 Wi-23, Fond Du Lac, WI 54935 | 2020-09-18 |
| 1891341988 | Cynthia Louise Singleton | Nurse Practitioner | 16 E 13th St., Fond Du Lac, WI 54935 | 2019-08-14 |
| 1083183297 | Elena Alexandra Giese | Nurse Practitioner | 430 E. Division St, Fond Du Lac, WI 54935 | 2018-11-16 |
| 1669963740 | Elizabeth Anne Machi | Student in an Organized Health Care Education/Training Program | 885 Western Ave Ste 300, Fond Du Lac, WI 54935 | 2018-05-23 |
| 1184150021 | Jordan Moehn | Specialist/Technologist | 633 Prairie Pkwy, Fond Du Lac, WI 54935 | 2017-05-11 |
| 1467856336 | Chuentao Ho | Specialist/Technologist | 45 South National Ave., Fond Du Lac, WI 54935 | 2014-10-21 |
| 1437587961 | Paula Seeley | Nurse Practitioner | 63 West Pioneer Rd, Fond Du Lac, WI 54935 | 2013-10-18 |
| 1144516030 | Bonnie Kay Mallon | Registered Nurse | 118 E 9th St, Fond Du Lac, WI 54935 | 2011-06-20 |
| 1770885600 | Holly Shepard | Counselor | 23 W Scott St., Fond Du Lac, WI 54935 | 2010-11-29 |
| 1437479110 | Ruth Marie Bohn | Occupational Therapy Assistant | 244 North Macy Street, Fond Du Lac, WI 54935 | 2010-06-04 |
| Find all providers in zip 54935 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538594783 | Lakeside Neurocare | Psychiatry & Neurology | 210 Wisconsin American Dr, Fond Du Lac, WI 54937-2999 | 2013-09-06 |
| 1174625610 | Steven A Sandstrom | Psychiatry & Neurology | 210 Wisconsin American Dr, Fond Du Lac, WI 54937-2999 | 2006-09-04 |
| 1811935752 | Xian Feng Gu | Psychiatry & Neurology | 420 E Division St, Fond Du Lac, WI 54935-4560 | 2006-06-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689162661 | Tseun Han James Kong | Psychiatry & Neurology | Uw Hospitals and Clinics, 600 Highland Ave, Madison, WI 53792 | 2018-04-25 |
| 1235630625 | The Cervical Spine Institute and Neuromonitoring, LLC | Psychiatry & Neurology | 2221 S Webster Ave # 268, Green Bay, WI 54301-2158 | 2018-02-22 |
| 1235647793 | Midwest Monitoring, LLC | Psychiatry & Neurology | 4321 W College Ave Ste 200, Appleton, WI 54914 | 2018-01-18 |
| 1477937274 | Baycare Clinic LLP | Psychiatry & Neurology | 4801 Expo Drive, Manitowoc, WI 54220 | 2015-07-13 |
| 1184011975 | Abdulrahim Ismail | Psychiatry & Neurology | 3003 University Dr Ste 203, Marinette, WI 54143-4110 | 2015-04-20 |
| 1033505821 | Heydi Flores Podadera | Psychiatry & Neurology | 721 N Midvale Blvd, Madison, WI 53705-3233 | 2015-04-08 |
| 1104221092 | Sharon Anne Bremer | Psychiatry & Neurology | 423 Landimore Ln, Wales, WI 53183-9552 | 2014-11-04 |
| 1891120093 | Robert T Schmidt Jr. | Psychiatry & Neurology | 2460 Old Plank Rd, De Pere, WI 54115-8658 | 2013-09-06 |
| 1356656771 | Klasinski Neurocare, Sc | Psychiatry & Neurology | 500 Vincent St Ste B, Stevens Point, WI 54481-1842 | 2010-08-10 |
| 1497931661 | Audrey Jantzen | Psychiatry & Neurology | 1685 Highland Ave, Department of Neurology - Centennial Building, Madison, WI 53705-2281 | 2008-01-17 |
| Find all providers with the same taxonomy | ||||
| City | FOND DU LAC |
| Zip Code | 54935 |
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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.