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Organization

LAKESHORE MEDICAL CLINIC, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KARA RICHARDSON (ASST TREASURER)
(704) 631-0450
Entity
Organization

Contact information

Practice address
S68W15500 JANESVILLE RD, MUSKEGO, WI 53150-2613
(414) 764-3241
(414) 762-4225
Mailing address
100 15TH AVE STE 180, SOUTH MILWAUKEE, WI 53172-1160
(414) 768-5430
(414) 762-4225

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary

Other

Enumeration date
08/16/2012
Last updated
10/14/2025
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