LAKESIDE FAMILY PRACTICE NPI 1831698430

NPI Information

NPI: 1831698430
Provider Name: LAKESIDE FAMILY PRACTICE
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

Address:
3200 SHERIDAN RD STE 104
KENOSHA, WI
ZIP 53140
Phone: (262) 225-1014
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LAKESIDE FAMILY PRACTICE is a family nurse practitioner in Kenosha, WI. LAKESIDE FAMILY PRACTICE NPI is 1831698430. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

3200 SHERIDAN RD STE 104
KENOSHA, WI
ZIP 53140-921
Phone: (262) 225-1014

The provider's authorized official is Anthony Hale .
The authorized official title is Owner and has the following contact phone number (262) 225-1014.

The enumeration date for this NPI number is 2/8/2018 and was last updated on 2/8/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	2011006054	WISCONSIN	Yes
2	363LG0600X	Nurse Practitioner	Gerontology	6190-33	WISCONSIN	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	100043522	MEDICAID	WISCONSIN
2	100018824	MEDICAID	WISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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