Provider Demographics
NPI:1710046404
Name:LAKESIDE NEUROCARE LIMITED
Entity Type:Organization
Organization Name:LAKESIDE NEUROCARE LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-223-5582
Mailing Address - Street 1:2700 W 9TH AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7865
Mailing Address - Country:US
Mailing Address - Phone:920-223-5580
Mailing Address - Fax:920-223-5592
Practice Address - Street 1:2700 W 9TH AVE STE 225
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7865
Practice Address - Country:US
Practice Address - Phone:920-223-5580
Practice Address - Fax:920-223-5592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty