Provider Demographics
NPI:1659343754
Name:JOHN S LANHAM DPM & ASSOCIATES SC
Entity Type:Organization
Organization Name:JOHN S LANHAM DPM & ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:LANHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:414-541-5566
Mailing Address - Street 1:5720 W OKLAHOMA AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53219
Mailing Address - Country:US
Mailing Address - Phone:414-541-5566
Mailing Address - Fax:414-541-6022
Practice Address - Street 1:5720 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53219-4301
Practice Address - Country:US
Practice Address - Phone:414-541-5566
Practice Address - Fax:414-541-6022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI750213E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
86419Medicare ID - Type Unspecified
U70862Medicare UPIN
1224810001Medicare NSC