Organization
LAKE COUNTRY PRIVATE MEDICAL, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICK T FITZGERALD MD (OWNER)
(262) 567-5190
Entity
Organization
Contact information
Practice address
1185 CORPORATE CENTER DR STE 300, OCONOMOWOC, WI 53066-4887
(262) 567-5190
(262) 567-5259
Mailing address
1185 CORPORATE CENTER DR STE 300, OCONOMOWOC, WI 53066-4887
(262) 567-5190
(262) 567-5259
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
48412
WI
Other
Enumeration date
02/17/2012
Last updated
05/18/2012
Update your record
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