Organization
LAKESIDE NEUROCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN M GOLDEN (BUSINESS MANAGER)
(920) 223-5582
Entity
Organization
Contact information
Practice address
933 NEWBURY ST, RIPON, WI 54971-1730
(920) 223-5580
(920) 223-3580
Mailing address
2700 W 9TH AVE STE 225, OSHKOSH, WI 54904-7865
(920) 223-5580
(920) 223-3580
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
36421
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32820600
—
WI
Enumeration date
05/22/2013
Last updated
05/22/2013
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