Organization
LAKE COUNTRY PAIN TREATMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID I STEIN (OWNER)
(414) 257-4673
Entity
Organization
Contact information
Practice address
970 S SILVER LAKE ST, SUITE 106, OCONOMOWOC, WI 53066-3802
(262) 560-9400
Mailing address
970 S SILVER LAKE ST, SUITE 106, OCONOMOWOC, WI 53066-3802
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
08/23/2007
Last updated
08/24/2007
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