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
331 E PUETZ RD, OAK CREEK, WI 53154-3254
(414) 570-3590
Mailing address
331 E PUETZ RD, OAK CREEK, WI 53154-3254
(414) 570-3590
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
06/18/2007
Last updated
04/06/2017
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