Organization
LAKESHORE MEDICAL CLINIC, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MASOOD WASIULLAH MD (PRESIDENT)
(414) 389-2377
Entity
Organization
Contact information
Practice address
2424 S 90TH ST, WEST ALLIS, WI 53227-2455
(414) 328-8777
Mailing address
2424 S 90TH ST, WEST ALLIS, WI 53227-2455
(414) 328-8777
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
06/20/2007
Last updated
07/29/2009
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