NPIMap

Organization Active NPI

Lakeshore Medical Clinic LTD

  • Durable Medical Equipment & Medical Supplies
  • Hales Corners, WI
National Provider Identifier
1740589399
Registry record updated Mar 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
LAKESHORE MEDICAL CLINIC LTD
Practice address
5250 S 108TH St
Hales Corners, WI 53130-1321
Phone
(414) 525-2433
Fax
(414) 525-2421
NPI assigned
Mar 22, 2011
Last updated
Mar 22, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2011

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

Authorized official

Name
Masood Wasiullah, MDNPI 1194803692
Title
President
Phone
(414) 744-6589

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

5250 S 108TH St
Hales Corners, WI 53130-1321

Mailing address

5250 S 108TH St
Hales Corners, WI 53130-1321
Phone (414) 525-2433

National Provider Directory

National Provider Directory
Tax ID family
Lakeshore Medical7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5250 S 108th St
Hales Corners, WI 53130
Phone (414) 296-1730

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1300752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300752000000",
    "number": "1740589399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5250 S 108TH ST",
            "city": "HALES CORNERS",
            "state": "WI",
            "postal_code": "531301321",
            "telephone_number": "414-525-2433",
            "fax_number": "414-525-2421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5250 S 108TH ST",
            "city": "HALES CORNERS",
            "state": "WI",
            "postal_code": "531301321",
            "telephone_number": "414-525-2433",
            "fax_number": "414-525-2421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE MEDICAL CLINIC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-22",
        "last_updated": "2011-03-22",
        "status": "A",
        "authorized_official_last_name": "WASIULLAH",
        "authorized_official_first_name": "MASOOD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-744-6589",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hales Corners, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2011; 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.