Dr Agnes Prospere, MD | |
200 E Ryan Rd, Oak Creek, WI 53154-4563 | |
(414) 570-3590 | |
Not Available |
Full Name | Dr Agnes Prospere |
---|---|
Gender | Female |
Speciality | Family Medicine |
Location | 200 E Ryan Rd, Oak Creek, Wisconsin |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1083241301 | NPI | - | NPPES |
100213444 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 80102-20 (Wisconsin) | Primary |
Entity Name | Lakeshore Medical Clinic Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1003861188 PECOS PAC ID: 7719890730 Enrollment ID: O20031106000481 |
Mailing Address | Practice Location Address |
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Dr Agnes Prospere, MD Po Box 735044, Chicago, IL 60673-4329 Ph: (414) 570-3590 | Dr Agnes Prospere, MD 200 E Ryan Rd, Oak Creek, WI 53154-4563 Ph: (414) 570-3590 |
Shereen Mohis, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 200 E Ryan Rd, Oak Creek, WI 53154 Phone: 414-570-3590 | |
Dr. Jessica Lynn Woznick, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 7901 S 6th St, Oak Creek, WI 53154 Phone: 414-346-8000 Fax: 414-346-8010 | |
Heather Butler, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 8020 S Howell Ave, Oak Creek, WI 53154 Phone: 414-647-3920 | |
Sara Hasan, Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 7901 S 6th St, Oak Creek, WI 53154 Phone: 414-346-8000 | |
Veronica Tent, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 7901 S 6th St, Oak Creek, WI 53154 Phone: 414-346-8000 | |
Deborah A Luetzow, MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 2413 W Rawson Ave, Oak Creek, WI 53154 Phone: 414-333-0064 |