| Lmg Inc | |
|
W3134 Van Roy Rd Appleton WI 54915-3982 | |
| (920) 882-1710 | |
| (920) 882-1708 |
| Full Name | Lmg Inc |
|---|---|
| Speciality | Dentist |
| Location | W3134 Van Roy Rd, Appleton, Wisconsin |
| Authorized Official Name and Position | Jay L Mackman (OWNER-DIRECTOR) |
| Authorized Official Contact | 4144769400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lmg Inc 2626 N 76th St Suite 105 Wauwatosa WI 53213-1137 Ph: (414) 476-9400 | Lmg Inc W3134 Van Roy Rd Appleton WI 54915-3982 Ph: (920) 882-1710 |
| NPI Number | 1063951663 |
|---|---|
| Provider Enumeration Date | 02/15/2017 |
| Last Update Date | 08/28/2023 |
| Medicare PECOS PAC ID | 6305851676 |
|---|---|
| Medicare Enrollment ID | O20170217000078 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063951663 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0106X | Dentist - Oral And Maxillofacial Pathology | (* (Not Available)) | Primary |
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