Organization
LAKESHORE MEDICAL CLINIC, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MASOOD WASIULLAH MD (PRESIDENT)
(414) 744-6589
Entity
Organization
Contact information
Practice address
5818 W CAPITOL DR, MILWAUKEE, WI 53216-2247
(414) 449-2114
Mailing address
5818 W CAPITOL DR, MILWAUKEE, WI 53216-2247
(414) 449-2114
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
06/18/2007
Last updated
08/22/2020
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