Lakeshore Medical Clinic LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

LAKESHORE MEDICAL CLINIC LLC

Practice address

5900 S Lake Dr
Cudahy, WI 53110-3171

Phone

(414) 489-4190

NPI assigned

Dec 26, 2006

Last updated

Oct 14, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kara Richardson

Title

Asst Treasurer

Phone

(704) 631-0450

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Lakeshore Medical Clinic LLC

  • Durable Medical Equipment & Medical Supplies
  • Oak Creek, WI
  • NPI 1154840163

  7719890730

  Same PAC ID
• Lakeshore Medical Clinic, LLC

  • Family Medicine Physician
  • St Francis, WI
  • NPI 1003861188

  7719890730

  Same PAC ID
• Lakeshore Medical Clinic, LLC

  • Durable Medical Equipment & Medical Supplies
  • South Milwaukee, WI
  • NPI 1114087053

  7719890730

  Same PAC ID
• Lakeshore Medical Clinic, LLC

  • Durable Medical Equipment & Medical Supplies
  • St Francis, WI
  • NPI 1669646287

  7719890730

  Same PAC ID
• Lakeshore Medical Clinic, LLC

  • Durable Medical Equipment & Medical Supplies
  • Muskego, WI
  • NPI 1922356252

  7719890730

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

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

• Aurora Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Hustisford, WI
  • NPI 1528193174

  Member Of

  NPD member

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760400000000",
    "number": "1265597645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 S LAKE DR",
            "city": "CUDAHY",
            "state": "WI",
            "postal_code": "531103171",
            "telephone_number": "414-489-4190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 S LAKE DR",
            "city": "CUDAHY",
            "state": "WI",
            "postal_code": "531103171",
            "telephone_number": "414-489-4190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-26",
        "last_updated": "2025-10-14",
        "certification_date": "2025-10-14",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "KARA",
        "authorized_official_title_or_position": "ASST TREASURER",
        "authorized_official_telephone_number": "704-631-0450"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S price Rd STE B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kristie Marie Koney, APNP
• Hilary Korb
• Venelin Kounev, MD
• Harold Krueger, R.PH.
• Daniel T Kult, D.D.S
• Stephen C Lamberton, MD
• Gina Landry, DPT
• Justin Robert Lee, PTA
• Sangha Sandra Lee, PHARM. D.
• Jaclynn Ann Lien-Skubal, APNP

• Durable Medical Equipment & Medical Supplies in Cudahy, WI
• Providers in Cudahy, WI by specialty
• Durable Medical Equipment & Medical Supplies in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.