Provider Demographics
NPI:1811212558
Name:5720 W. OKLAHOMA AVENUE, LLC
Entity Type:Organization
Organization Name:5720 W. OKLAHOMA AVENUE, LLC
Other - Org Name:GREATER MILWAUKEE FOOT & ANKLE AMBULATORY SURGERY CENTER
Other - Org Type:Doing Business As
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 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 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:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical