Organization
LAKESIDE NEUROCARE LIMITED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN M GOLDEN (BUSINESS MANAGER)
(920) 223-5582
Entity
Organization
Contact information
Practice address
620 W BROWN ST, WAUPUN, WI 53963-1702
(920) 223-5580
(920) 223-3580
Mailing address
2700 W 9TH AVE STE 225, OSHKOSH, WI 54904-7865
(920) 223-5582
(920) 223-3580
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
36421
WI
Other
Enumeration date
08/09/2018
Last updated
08/09/2018
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