Lake Side Surgical Associates SC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

LAKE SIDE SURGICAL ASSOCIATES SC

Practice address

1843 Michigan St
Sturgeon Bay, WI 54235-1007

Phone

(920) 746-1060

Fax

(920) 746-1072

NPI assigned

Jun 10, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Michael T Herlache

Title

Administrator

Phone

(920) 746-1060

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Herlache, MD

  • Specialist
  • Sturgeon Bay, WI
  • NPI 1801053319
  NPD (past)
• Thomas Joseph Johnson, MD

  • Surgery Physician
  • Osceola, WI
  • NPI 1104892900
  NPD (past)

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1699779355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 678",
            "city": "STURGEON BAY",
            "state": "WI",
            "postal_code": "542350678",
            "telephone_number": "920-746-1060",
            "fax_number": "920-746-1072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1843 MICHIGAN ST",
            "city": "STURGEON BAY",
            "state": "WI",
            "postal_code": "542351007",
            "telephone_number": "920-746-1060",
            "fax_number": "920-746-1072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SIDE SURGICAL ASSOCIATES SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HERLACHE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "920-746-1060",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor M Kubicek, DNP, FNP-C
• Ross Jared Kulick, DPT
• Amanda M Kuntz, PT, DPT, CLT
• Andrzej P Kurek, MD
• Shawn W Laibly, MD
• Crystal Laluzerne, APNP
• Rhawn Gayhead Lampkins, COTA
• Eric J Lardinois, PHARMD
• McKenna Patricia Larsen, D-PT
• Jillian Laurent, OTR

• Specialist in Sturgeon Bay, WI
• Providers in Sturgeon Bay, WI by specialty
• Specialist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.