Organization
PADDOCK LAKE FAMILY PRACTICE, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA M THOMAS (BILLING MANAGER)
(262) 843-2394
Entity
Organization
Contact information
Practice address
7137 236TH AVE, SUITE 103, SALEM, WI 53168-9664
(262) 843-4422
(262) 843-1166
Mailing address
7137 236TH AVE, SUITE 103, SALEM, WI 53168-9664
(262) 843-4422
(262) 843-1166
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21291800
—
WI
01
—
DD7478
RAIL ROAD MEDICARE
—
Enumeration date
04/05/2006
Last updated
04/20/2008
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