# LAKE COUNTRY PRIVATE MEDICAL, S.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720351919
- **Authorized official:** DR. PATRICK T FITZGERALD MD (OWNER)
- **Authorized official phone:** (262) 567-5190

## Contact information

- **Practice address:** 1185 CORPORATE CENTER DR STE 300, OCONOMOWOC, WI 53066-4887
- **Practice address phone:** (262) 567-5190
- **Practice address fax:** (262) 567-5259
- **Mailing address:** 1185 CORPORATE CENTER DR STE 300, OCONOMOWOC, WI 53066-4887
- **Mailing address phone:** (262) 567-5190
- **Mailing address fax:** (262) 567-5259

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 48412 | WI | Yes |

## Other

- **Enumeration date:** 02/17/2012
- **Last updated:** 05/18/2012