| Lauri Green M.d. S.c. | |
|
1177 Quail Ct Suite 101 Pewaukee WI 53072-3790 | |
| (262) 695-1212 | |
| (262) 695-1919 |
| Full Name | Lauri Green M.d. S.c. |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 1177 Quail Ct, Pewaukee, Wisconsin |
| Authorized Official Name and Position | Lauri Theresa Green (OWNER) |
| Authorized Official Contact | 2626951212 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lauri Green M.d. S.c. 1177 Quail Ct Suite 101 Pewaukee WI 53072-3790 Ph: (262) 695-1212 | Lauri Green M.d. S.c. 1177 Quail Ct Suite 101 Pewaukee WI 53072-3790 Ph: (262) 695-1212 |
| NPI Number | 1710992268 |
|---|---|
| Provider Enumeration Date | 07/30/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710992268 | NPI | - | NPPES |
| 32265500 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 38185 (Wisconsin) | Primary |
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