Organization
LAKESHORE MEDICAL CLINIC, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MASOOD WASIULLAH MD (PRESIDENT)
(414) 768-5430
Entity
Organization
Contact information
Practice address
8905 W LINCOLN AVE STE 409, WEST ALLIS, WI 53227-2469
(414) 328-8770
Mailing address
PO BOX 371280, MILWAUKEE, WI 53237-2380
(414) 328-8770
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
01/19/2007
Last updated
12/08/2010
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