Organization
LAKE SIDE SURGICAL ASSOCIATES SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL T HERLACHE (ADMINISTRATOR)
(920) 746-1060
Entity
Organization
Contact information
Practice address
1843 MICHIGAN ST, STURGEON BAY, WI 54235-1007
(920) 746-1060
(920) 746-1072
Mailing address
PO BOX 678, STURGEON BAY, WI 54235-0678
(920) 746-1060
(920) 746-1072
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
06/10/2005
Last updated
08/22/2020
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