Organization
LAKESHORE MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MASOOD WASIULLAH MD (PRESIDENT)
(414) 525-2433
Entity
Organization
Contact information
Practice address
4444 WEST LOOMIS ROAD, 200, GREENFIELD, WI 53220
(414) 281-5150
Mailing address
100 15TH AVE, SOUTH MILWAUKEE, WI 53172-1160
(414) 764-3241
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
Other
Enumeration date
06/12/2012
Last updated
06/12/2012
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