Organization
LAKESHORE MEDICAL CLINIC, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MASOOD WASIULLAH MD (PRESIDENT/CEO)
(414) 764-3241
Entity
Organization
Contact information
Practice address
4131 W LOOMIS RD, STE 200, GREENFIELD, WI 53221-2051
(414) 281-5151
Mailing address
4131 W LOOMIS RD, STE 200, GREENFIELD, WI 53221-2051
(414) 281-5151
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
11/01/2006
Last updated
08/22/2020
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