| Lakeshore Clinic Ltd | |
|
3970 N Oakland Ave Suite 502 Milwaukee WI 53211 | |
| (414) 962-9909 | |
| (414) 332-8596 |
| Full Name | Lakeshore Clinic Ltd |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 3970 N Oakland Ave, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Patricia K Briceno (ADMINISTRATOR) |
| Authorized Official Contact | 4149629909 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeshore Clinic Ltd 3970 N Oakland Ave Suite 502 Milwaukee WI 53211 Ph: (414) 962-9909 | Lakeshore Clinic Ltd 3970 N Oakland Ave Suite 502 Milwaukee WI 53211 Ph: (414) 962-9909 |
| NPI Number | 1407925985 |
|---|---|
| Provider Enumeration Date | 11/07/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407925985 | NPI | - | NPPES |
| 42106900 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 1497 (Wisconsin) | Primary |
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