Organization
LAKESIDE NEUROCARE LIMITED.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN M GOLDEN CPC (BUSINESS MANAGER)
(920) 223-5582
Entity
Organization
Contact information
Practice address
430 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 923-5526
(920) 923-5871
Mailing address
2700 W 9TH AVE STE 225, OSHKOSH, WI 54904-7865
(920) 223-5580
(920) 223-5592
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32820600
—
WI
Enumeration date
08/14/2007
Last updated
04/13/2012
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