LAKESHORE MEDICAL CLINIC, LLC (NPI# 1962607366) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962607366 |
| Entity Type | Organization |
| Organization Name | LAKESHORE MEDICAL CLINIC, LLC |
| Practice Address |
14555 W National Ave Ste 165 New Berlin WI 53151-4494 |
| Mailing Address |
3301 W Forest Home Ave Payor Activation Milwaukee WI 53215-2843 |
| Practice Telephone | 2628272959 |
| Mailing Telephone | 4146476326 |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2017-07-20 |
| Authorized Official Name | MICHAEL BANIA (SENIOR DIRECTOR) |
| Authorized Official Telephone | 4147669094 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922356252 | Lakeshore Medical Clinic, LLC | Durable Medical Equipment & Medical Supplies | S68w15500 Janesville Rd, Muskego, WI 53150-2613 | 2012-08-16 |
| 1669646287 | Lakeshore Medical Clinic, LLC | Durable Medical Equipment & Medical Supplies | 2000 E Layton Ave, Saint Francis, WI 53235-6053 | 2008-04-15 |
| 1790980191 | Lakeshore Medical Clinic, LLC | Durable Medical Equipment & Medical Supplies | 3305 S 20th St, Milwaukee, WI 53215-4940 | 2007-06-18 |
| 1114087053 | Lakeshore Medical Clinic, LLC | Durable Medical Equipment & Medical Supplies | 3611 S Chicago Ave, South Milwaukee, WI 53172-3708 | 2006-12-11 |
| 1003861188 | Lakeshore Medical Clinic, LLC | Clinic/Center | 2000 E Layton Ave, Ste 100, Milwaukee, WI 53235-6053 | 2006-05-24 |
| Street Address |
14555 W NATIONAL AVE STE 165 |
| City | NEW BERLIN |
| State | WI |
| Zip Code | 53151-4494 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962495978 | Richard D. Basile | Internal Medicine | 14555 W National Ave, Suite 170, New Berlin, WI 53151-4494 | 2005-08-24 |
| 1629685110 | Courtney Amborn | Physical Therapist | 14555 W National Ave, New Berlin, WI 53151-4494 | 2020-09-28 |
| 1629613799 | Daniel Delach | Physical Therapist | 14555 W National Ave, New Berlin, WI 53151-4494 | 2019-11-13 |
| 1730604935 | Courtney Malina Kinney | Physical Therapist | 14555 W National Ave, New Berlin, WI 53151-4494 | 2017-08-08 |
| 1942741756 | Gena Scales | Physical Therapist | 14555 W National Ave, New Berlin, WI 53151-4494 | 2017-03-13 |
| 1578014601 | Maria Cook | Physical Therapist | 14555 W National Ave, Suite 195, New Berlin, WI 53151-4494 | 2016-10-24 |
| 1427501014 | Jeeyoon Kristy Kang | Pharmacist | 14555 W National Ave, New Berlin, WI 53151-4494 | 2016-07-29 |
| 1639575442 | Karen Heintz | Pharmacist | 14555 W National Ave, New Berlin, WI 53151-4494 | 2014-11-06 |
| 1992107163 | Weizhong Song | Physician Assistant | 14555 W National Ave, Suite 120, New Berlin, WI 53151-4494 | 2014-09-19 |
| 1487074910 | Leah Probst | Internal Medicine | 14555 W National Ave, New Berlin, WI 53151-4494 | 2014-04-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629527486 | Natural Look Salon and Wigs LLC | Durable Medical Equipment & Medical Supplies | 4805 S. Moorland Rd, New Berlin, WI 53151 | 2016-09-22 |
| 1396193033 | New Berlin Medical Services, LLC | Clinic/Center | 15324 W Beloit Road, New Berlin, WI 53151 | 2016-06-02 |
| 1063899680 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 15300 West Grange Avenue, New Berlin, WI 53151 | 2015-05-04 |
| 1871970368 | Mary Spath | Physical Therapy Assistant | 2810 South Acredale Road, New Berlin, WI 53151 | 2015-05-04 |
| 1669885471 | Wauwatosa Prescription Center, Inc. | Pharmacy | 4855 S Moorland Road, New Berlin, WI 53151 | 2014-06-09 |
| 1750711446 | Pure Family Chiropractic LLC | Chiropractor | 3504 S. Moorland Road, New Berlin, WI 53151 | 2013-11-18 |
| 1336578202 | Hamilton John Dowden | Chiropractor | 3504 S Moorland Rd, New Berlin, WI 53151 | 2013-11-01 |
| 1053653618 | Danielle Lynn Lucio | Acupuncturist | 15807 W. National Ave., New Berlin, WI 53151 | 2013-03-21 |
| 1306195110 | Marlena J Friedrich | Registered Nurse | 1709 S. 171st Street, New Berlin, WI 53151 | 2012-09-07 |
| 1548519176 | Patricia M Friedrich | Licensed Practical Nurse | 1709 So. 171st Street, New Berlin, WI 53151 | 2012-08-29 |
| Find all providers in zip 53151 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629527486 | Natural Look Salon and Wigs LLC | Durable Medical Equipment & Medical Supplies | 4805 S. Moorland Rd, New Berlin, WI 53151 | 2016-09-22 |
| 1346587904 | Integra Healthcare Equipment of Wisconsin, LLC | Durable Medical Equipment & Medical Supplies | 2855 S 160th St, New Berlin, WI 53151-3603 | 2013-01-15 |
| 1174821847 | Health Support Services | Durable Medical Equipment & Medical Supplies | 15350 W National Ave Ste 109, New Berlin, WI 53151-5158 | 2011-03-04 |
| 1427383728 | Orbit Medical of Milwaukee Inc | Durable Medical Equipment & Medical Supplies | 2925 S 160th St, New Berlin, WI 53151-3605 | 2009-10-05 |
| 1396961421 | Dbo Holdings, LLC | Durable Medical Equipment & Medical Supplies | 14520 W Maylore Ct, New Berlin, WI 53151-1215 | 2007-04-17 |
| 1770635609 | Home Care Medical, Inc | Durable Medical Equipment & Medical Supplies | 2604 S 162nd St, New Berlin, WI 53151-2810 | 2007-01-18 |
| 1841209780 | Sizewise Rentals LLC | Durable Medical Equipment & Medical Supplies | 16312 W Glendale Dr, New Berlin, WI 53151-2842 | 2006-08-07 |
| 1811919517 | Wisconsin Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 4798 S Moorland Rd, New Berlin, WI 53151-7486 | 2006-07-24 |
| 1154348225 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 15205 W Greenfield Ave, New Berlin, WI 53151-1519 | 2006-07-16 |
| 1851328157 | Home Care Medical, Inc | Durable Medical Equipment & Medical Supplies | 5665 S Westridge Dr, Suite 100, New Berlin, WI 53151-7954 | 2006-06-26 |
| Find all providers in NEW BERLIN | ||||
| City | NEW BERLIN |
| Zip Code | 53151 |
Please comment or provide details below to improve the information on LAKESHORE MEDICAL CLINIC, LLC.
| 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.