Provider Demographics
NPI:1073391447
Name:LMG INC
Entity Type:Organization
Organization Name:LMG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-476-9400
Mailing Address - Street 1:2626 N 76TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-1137
Mailing Address - Country:US
Mailing Address - Phone:414-443-9283
Mailing Address - Fax:414-771-7731
Practice Address - Street 1:7001 S HOWELL AVE STE 800
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-1408
Practice Address - Country:US
Practice Address - Phone:414-856-9990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty