Organization
LAKESHORE MEDICAL CLINIC LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MASOOD WASIULLAH MD (PRESIDENT)
(414) 744-6589
Entity
Organization
Contact information
Practice address
5250 S 108TH ST, HALES CORNERS, WI 53130-1321
(414) 525-2433
(414) 525-2421
Mailing address
5250 S 108TH ST, HALES CORNERS, WI 53130-1321
(414) 525-2433
(414) 525-2421
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
03/22/2011
Last updated
03/22/2011
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