Lakeshore Medical Clinic, LLC
Organization Active NPI Durable Medical Equipment & Medical Supplies · Saint Francis, WI
NPI 1669646287 · NPPES record last updated Oct 14, 2025
Key facts
- NPI
- 1669646287
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Durable Medical Equipment & Medical Supplies 332B00000X
- Legal business name
- LAKESHORE MEDICAL CLINIC, LLC
- Practice address
- 2000 E Layton Ave
Saint Francis, WI 53235-6053 - Phone
- (414) 744-6589
- NPI assigned
- Apr 15, 2008
- Organization subpart
- No
Authorized official
- Name
- Kara Richardson
- Title
- Asst Treasurer
- Phone
- (704) 631-0450
Other NPIs with the same Medicare PAC ID 5
Corporate family (same tax ID) 6
Member of 1
Practitioners 375
-
Alyssa Aldridge, PA-C, MPAS
-
Fatima Ali, D.O
-
Tarek Amin, D.O.
-
Roger Axtell, M.D.
-
Sarang Baman, MD
-
Adam Basler, M.D.
-
David Leon Baugh, M.D.
-
Caylee Ann Beckman, DPT, PT, LAT, ATC
-
Rachel O Beine, PA
-
Dinesh Jethu Belani, M. D.
-
Rosa Marie Bell, PT, DPT
-
Nancy Blankenship, M.D.
-
Brenda Blunt, APNP
-
Brandon Charles Bodager, M.D.
-
Bridget Bodenbach, PA-C
-
Ashlyn Bolstad, NP
-
Anand Brahmamdam, DO
-
Harry M. Brammer, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930059099 | WI | DME Supplier - Multi-Specialty - Physician |
7719890730 | Practice locations: St Francis, WI |
National Provider Directory
- Tax ID family
- Lakeshore Medical Group
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | Yes |
Addresses
Primary practice location
2000 E Layton Ave
Saint Francis, WI 53235-6053
Mailing address
2000 E Layton Ave
Saint Francis, WI 53235-6053
Phone (414) 744-6589
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Other providers in Saint Francis, WI
- Carrie Kohlstedt
- Rachel Leigh Kordonskiy
- Sridevi Koritala
- Linda Sue Lafore
- Lakeshore Medical Clinic, LLC
- Bridget K Larson
- Zachary R Laste
- Bryan J Laundre
- Mark Thomas Lawton
- John R Linscott Jr.
All providers in Saint Francis, WI · Durable Medical Equipment & Medical Supplies in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.