Organization
GREAT LAKES PAIN SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY STAACKE M.D. (PARTNER)
(262) 787-4026
Entity
Organization
Contact information
Practice address
8153 S 27TH ST, FRANKLIN, WI 53132-7012
(414) 761-1802
Mailing address
225 S EXECUTIVE DR, BROOKFIELD, WI 53005-4257
(262) 787-4026
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Enumeration date
07/30/2009
Last updated
07/30/2009
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