Lakeside Neurocare Limited

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

Legal business name

LAKESIDE NEUROCARE LIMITED

Practice address

191 Memorial Dr
Berlin, WI 54923-1241

Phone

(920) 223-5580

Fax

(920) 223-5592

NPI assigned

Aug 14, 2007

Last updated

Apr 13, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Susan M Golden, CPC

Title

Business Manager

Phone

(920) 223-5582

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1187049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334275200000",
    "number": "1932391968",
    "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": "920-223-5580",
            "fax_number": "920-223-5592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 MEMORIAL DR",
            "city": "BERLIN",
            "state": "WI",
            "postal_code": "549231241",
            "telephone_number": "920-223-5580",
            "fax_number": "920-223-5592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE NEUROCARE LIMITED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-14",
        "last_updated": "2012-04-13",
        "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",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32820600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diane Marie Klika, PT
• Benjamin John Kozloski, CRNA
• Keith Anthony Krause, CRNA
• Stephanie Krause, PA
• Danielle Lynn Krueger, RD
• Lau Chiropractic and Wellness Center, LLC
• Christopher Roger Lau, DC
• Vy Vivian Le, DDS
• Kathleen J Legare, RD
• Hannah Jayne Lehocky, SLP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2012; 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.