Organization
LAKESHORE MEDICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BANIA (SENIOR DIRECTOR)
(414) 766-9094
Entity
Organization
Contact information
Practice address
3305 S 20TH ST, MILWAUKEE, WI 53215-4940
(414) 645-1808
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(414) 647-6326
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
06/18/2007
Last updated
07/20/2017
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