# SOUTHERN LAKES ENDOSCOPY LLC

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

## Provider details

- **NPI number:** 1851887715
- **Authorized official:** AMY JO BURNS (DIRECTOR REVENUE CYCLE MANAGEMENT)
- **Authorized official phone:** (262) 970-7825

## Contact information

- **Practice address:** 240 MAPLE AVE STE 2220, MUKWONAGO, WI 53149-8475
- **Practice address phone:** (414) 454-0600
- **Practice address fax:** (414) 454-0971
- **Mailing address:** 2801 W KINNICKINNIC RIVER PKWY STE 1080, MILWAUKEE, WI 53215-3689
- **Mailing address phone:** (414) 908-6615
- **Mailing address fax:** (414) 908-6634

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/03/2018
- **Last updated:** 03/19/2026