Organization
LIPID SPECIALISTS, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY P ELDRIDGE M.D. (PRESIDENT)
(262) 656-1911
Entity
Organization
Contact information
Practice address
1400 75TH ST, SUITE 5, KENOSHA, WI 53143-1544
(262) 656-1911
(262) 656-1911
Mailing address
1400 75TH ST, SUITE 5, KENOSHA, WI 53143-1544
(262) 656-1911
(262) 656-1911
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
54685-20
WI
Other
Enumeration date
10/26/2010
Last updated
10/26/2010
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