Organization Name: | LAKESHORE MEDICAL CLINIC LTD |
NPI Number: | 1124256391 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MASOOD WASUILLAH (PRESIDENT) |
Mailing Address: | 902 Milwaukee Ave South Milwaukee |
State: | WI US |
Postal Code: | 531722118 |
Phone Number: | 4147644003 |
Fax Number: | 4147644005 |
NPI Enumeration Date: | 06/26/2009 |
NPI Last Update Date: | 04/29/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |