NPIMap

Organization Active NPI

Lakeshore Medical Clinic LTD

Doing business as LMC Bucyrus Medical

  • Family Medicine Physician
  • South Milwaukee, WI
National Provider Identifier
1174851893
Registry record updated Apr 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LAKESHORE MEDICAL CLINIC LTD
Doing business as
LMC Bucyrus Medical
Practice address
1100 Milwaukee Ave
South Milwaukee, WI 53172-2013
Phone
(414) 764-4003
NPI assigned
Nov 19, 2009
Last updated
Apr 28, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Masood Wasiullah, MDNPI 1194803692
Title
President
Phone
(414) 744-6589

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1100 Milwaukee Ave
South Milwaukee, WI 53172-2013

Mailing address

100 15TH Ave
South Milwaukee, WI 53172-1160
Phone (414) 764-3241

Other names 1

  • LMC Bucyrus Medical Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031106000481 WI Part B Supplier - Clinic/Group Practice 7719890730 Receives reassigned benefits from 1,105 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

5900 S Lake Dr
Fl 2
Cudahy, WI 53110
Phone (414) 489-4190

163 N Milwaukee St
Milwaukee, WI 53202
Phone (414) 227-1127

2901 W Kinnickinnic River Pkwy
Ste 200
Milwaukee, WI 53215
Phone (414) 646-8995

4131 W Loomis Rd
Ste 110
Milwaukee, WI 53221
Phone (414) 281-3509

2000 E Layton Ave
Ste 140
St Francis, WI 53235
Phone (414) 769-8009

Practitioners & affiliated clinicians

Practitioners 356

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 356

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1258588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272412800000",
    "number": "1174851893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 15TH AVE",
            "city": "SOUTH MILWAUKEE",
            "state": "WI",
            "postal_code": "531721160",
            "telephone_number": "414-764-3241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 MILWAUKEE AVE",
            "city": "SOUTH MILWAUKEE",
            "state": "WI",
            "postal_code": "531722013",
            "telephone_number": "414-764-4003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE MEDICAL CLINIC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-19",
        "last_updated": "2010-04-28",
        "status": "A",
        "authorized_official_last_name": "WASIULLAH",
        "authorized_official_first_name": "MASOOD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-744-6589",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LMC Bucyrus Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.