Organization
LAKE COUNTRY PEDIATRICS SC
Active
Other names
Lake Country Physicians
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY M MOYER M.D. (DR.)
(262) 569-7100
Entity
Organization
Contact information
Practice address
970 S SILVER LAKE ST, STE. 102, OCONOMOWOC, WI 53066-3802
(262) 569-7100
(262) 567-6295
Mailing address
970 S SILVER LAKE ST, STE. 102, OCONOMOWOC, WI 53066-3802
(262) 569-7100
(262) 567-6295
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35710
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21250600
—
WI
Enumeration date
05/18/2006
Last updated
08/15/2011
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