| Organization Name: | LAKESHORE MEDICAL CLINIC, LTD |
| NPI Number: | 1215132055 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MASOOD WASIULLAH (PRESIDENT) |
| Mailing Address: | 2424 S 90th St West Allis |
| State: | WI US |
| Postal Code: | 532272455 |
| Phone Number: | 4143288777 |
| Fax Number: | |
| NPI Enumeration Date: | 06/20/2007 |
| NPI Last Update Date: | 07/29/2009 |
| 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 |