| Lakeside Neurocare | |
|
933 Newbury St Ripon WI 54971-1730 | |
| (920) 223-5580 | |
| (920) 223-3580 |
| Full Name | Lakeside Neurocare |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 933 Newbury St, Ripon, Wisconsin |
| Authorized Official Name and Position | Susan M Golden (BUSINESS MANAGER) |
| Authorized Official Contact | 9202235582 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Neurocare 2700 W 9th Ave Ste 225 Oshkosh WI 54904-7865 Ph: (920) 223-5580 | Lakeside Neurocare 933 Newbury St Ripon WI 54971-1730 Ph: (920) 223-5580 |
| NPI Number | 1669818266 |
|---|---|
| Provider Enumeration Date | 05/22/2013 |
| Last Update Date | 05/22/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669818266 | NPI | - | NPPES |
| 32820600 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 36421 (Wisconsin) | Primary |
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