Organization
LAKESHORE MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KARA RICHARDSON (ASST TREASURER)
(704) 631-0450
Entity
Organization
Contact information
Practice address
200 E RYAN RD, OAK CREEK, WI 53154-4563
(414) 570-3590
(414) 570-3599
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(414) 647-6326
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
09/12/2017
Last updated
10/14/2025
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