Lakeside Neurocare Limited

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

36421 Issued in WI

Legal business name

LAKESIDE NEUROCARE LIMITED

Practice address

620 W Brown St
Waupun, WI 53963-1702

Phone

(920) 223-5580

Fax

(920) 223-3580

NPI assigned

Aug 9, 2018

Organization subpart

No

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

Authorized official

Name

Susan M Golden

Title

Business Manager

Phone

(920) 223-5582

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1533772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533772800000",
    "number": "1497234686",
    "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": "920-223-5582",
            "fax_number": "920-223-3580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 W BROWN ST",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539631702",
            "telephone_number": "920-223-5580",
            "fax_number": "920-223-3580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE NEUROCARE LIMITED",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-09",
        "last_updated": "2018-08-09",
        "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"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WI",
            "license": "36421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peggy L Keuler, NP
• Kaye Koehoorn
• Gail Ann Krummen-Lee, PMHNP-BC
• Kazoua Kue
• Jace Lachapelle, DPT
• Kourtney Kaye Lechner Ullrich, MS LPC
• Panou Lee
• Samantha Lynn Lenzendorf
• Ying-CHI Li
• Ashley Lindahl, DOULA

• Neurology Physician in Waupun, WI
• Providers in Waupun, WI by specialty
• Neurology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2018; 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.