Lakeshore Medical Clinic

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

178111-30 Issued in WI

Legal business name

LAKESHORE MEDICAL CLINIC

Practice address

3305 S 20TH St
Suite 100
Milwaukee, WI 53215-4940

Phone

(414) 645-1808

NPI assigned

Jun 13, 2014

Organization subpart

No

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

Authorized official

Name

Frank Lavora, DPM

Title

Podiatrist

Phone

(414) 768-5430

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1402617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402617600000",
    "number": "1205240686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3305 S 20TH ST",
            "address_2": "SUITE 100",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532154940",
            "telephone_number": "414-645-1808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3305 S 20TH ST",
            "address_2": "SUITE 100",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532154940",
            "telephone_number": "414-645-1808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-13",
        "last_updated": "2014-06-13",
        "status": "A",
        "authorized_official_last_name": "LAVORA",
        "authorized_official_first_name": "FRANK",
        "authorized_official_title_or_position": "PODIATRIST",
        "authorized_official_telephone_number": "414-768-5430",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "178111-30",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake Park Dental LLC
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• Jacqueline Lake, NP
• Jodi Jay Lake, R.N.
• Lakeshore Clinic LTD
• Lakeshore Medical Clinic, LLC
• Lakeshore Medical Clinic, LTD
• Lakeshore Medical Clinic, LTD
• Lakeside Dental LLC
• Lakeside OB/GYN, S.C.

• Family Nurse Practitioner in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Family Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.