Organization
LAKESHORE MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE BANIA (ADMINISTRATOR)
(414) 744-6589
Entity
Organization
Contact information
Practice address
4448 W LOOMIS RD STE 204, GREENFIELD, WI 53220-4851
(414) 281-5151
Mailing address
4448 W LOOMIS RD STE 204, GREENFIELD, WI 53220-4851
(414) 281-5151
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
08/14/2007
Last updated
07/21/2022
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