Active NPI
Lakeside Neurocare
- Neurology Physician
- Oshkosh, WI
National Provider Identifier
1083048730
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- Legal business name
- LAKESIDE NEUROCARE
- Practice address
- 855 N Westhaven Dr
Oshkosh, WI 54904-7668 - Phone
- (920) 223-5580
- Fax
- (920) 223-3580
- NPI assigned
- Aug 29, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Susan M Golden, CPC
- Title
- Business Manager
- Phone
- (920) 223-5582
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | WI | Primary |
Addresses
Primary practice location
855 N Westhaven Dr
Oshkosh, WI 54904-7668
Mailing address
2700 W 9TH Ave Ste 225
Oshkosh, WI 54904-7865
Phone (920) 223-5580
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32820600 | Medicaid | WI |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377734400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1377734400000",
"number": "1083048730",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2700 W 9TH AVE STE 225",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549047865",
"telephone_number": "920-223-5580",
"fax_number": "920-223-3580"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "855 N WESTHAVEN DR",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549047668",
"telephone_number": "920-223-5580",
"fax_number": "920-223-3580"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LAKESIDE NEUROCARE",
"organizational_subpart": "NO",
"enumeration_date": "2013-08-29",
"last_updated": "2013-08-29",
"status": "A",
"authorized_official_last_name": "GOLDEN",
"authorized_official_first_name": "SUSAN",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "BUSINESS MANAGER",
"authorized_official_telephone_number": "920-223-5582",
"authorized_official_credential": "CPC"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Neurology",
"state": "WI",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "32820600",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Oshkosh, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.