Organization
LAKESHORE MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MASOOD WASIULLAH MD (PRESIDENT)
(262) 241-8000
Entity
Organization
Contact information
Practice address
10520 N PORT WASHINGTON RD, MEQUON, WI 53092-5537
(262) 241-8000
Mailing address
100 15TH AVE, SOUTH MILWAUKEE, WI 53172-1160
(414) 768-5430
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
06/23/2009
Last updated
06/23/2009
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