Lakeside Neurocare
Organization Active NPI Neurology Physician · Ripon, WI
NPI 1669818266 · NPPES record last updated May 22, 2013
Key facts
- NPI
- 1669818266
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Neurology Physician 2084N0400X
- License
- 36421 (WI)
- Legal business name
- LAKESIDE NEUROCARE
- Practice address
- 933 Newbury St
Ripon, WI 54971-1730 - Phone
- (920) 223-5580
- Fax
- (920) 223-3580
- NPI assigned
- May 22, 2013
- Organization subpart
- No
Authorized official
- Name
- Susan M Golden
- Title
- Business Manager
- Phone
- (920) 223-5582
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician |
2084N0400X | 36421 | WI | Yes |
Addresses
Primary practice location
933 Newbury St
Ripon, WI 54971-1730
Mailing address
2700 W 9TH Ave Ste 225
Oshkosh, WI 54904-7865
Phone (920) 223-5580
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32820600 | Medicaid | WI |
Other providers in Ripon, WI
- Brianne Huettner
- Cheryl J Iverson
- Christopher G Johnson
- Susan Kathryn Kelm
- Thomas B Kloosterboer
- Ashley Lamers
- Joe Lettenberger
- Lindsay A Loewe
- Joseph Longo
- Jeanne M Lyke
All providers in Ripon, WI · Neurology Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 22, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.