Provider Demographics
NPI:1598716342
Name:LASSER, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:LASSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11211 W LINCOLN AVE
Mailing Address - Street 2:LINCOLN AVENUE CLINIC
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-1035
Mailing Address - Country:US
Mailing Address - Phone:414-456-5900
Mailing Address - Fax:414-327-7639
Practice Address - Street 1:11211 W LINCOLN AVE
Practice Address - Street 2:LINCOLN AVENUE CLINIC
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1035
Practice Address - Country:US
Practice Address - Phone:414-456-5900
Practice Address - Fax:414-327-7639
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35601207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1598716342Medicaid
WI32371000Medicaid
002000217MOtherHUMANA
0055373601Medicare ID - Type Unspecified
WI1598716342Medicaid