Provider Demographics
NPI:1811185812
Name:LANHAM, JOHN STUART (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STUART
Last Name:LANHAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 W OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53219-4301
Mailing Address - Country:US
Mailing Address - Phone:414-541-5566
Mailing Address - Fax:414-541-6022
Practice Address - Street 1:5720 W OKLAHOMA AVENUE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53219
Practice Address - Country:US
Practice Address - Phone:414-541-5566
Practice Address - Fax:414-541-6022
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI750213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI86419Medicare PIN
WIU70862Medicare UPIN
WI86421Medicare PIN