Provider Demographics
NPI:1710512819
Name:LKW HEALTH LLC
Entity Type:Organization
Organization Name:LKW HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KASI
Authorized Official - Middle Name:
Authorized Official - Last Name:STANKEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-632-7158
Mailing Address - Street 1:106 N WISCONSIN ST
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-2733
Mailing Address - Country:US
Mailing Address - Phone:920-327-7056
Mailing Address - Fax:920-425-4955
Practice Address - Street 1:106 N WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-2733
Practice Address - Country:US
Practice Address - Phone:920-327-7056
Practice Address - Fax:920-425-4955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty