Individual
EDWARD LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
855 N WESTHAVEN DR, OSHKOSH, WI 54904-7668
(920) 303-5626
(920) 303-5632
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
29465
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31925100
—
WI
Enumeration date
08/18/2005
Last updated
10/31/2023
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