| Lakeside Neurocare Limited. | |
|
430 E Division St Fond Du Lac WI 54935-4560 | |
| (920) 923-5526 | |
| (920) 923-5871 |
| Full Name | Lakeside Neurocare Limited. |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 430 E Division St, Fond Du Lac, 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 Limited. 2700 W 9th Ave Ste 225 Oshkosh WI 54904-7865 Ph: (920) 223-5580 | Lakeside Neurocare Limited. 430 E Division St Fond Du Lac WI 54935-4560 Ph: (920) 923-5526 |
| NPI Number | 1225220254 |
|---|---|
| Provider Enumeration Date | 08/14/2007 |
| Last Update Date | 04/13/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225220254 | NPI | - | NPPES |
| 32820600 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (Wisconsin) | Primary |
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