Provider Demographics
NPI:1790224491
Name:LMG INC
Entity type:Organization
Organization Name:LMG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:D
Authorized Official - Phone:414-476-9400
Mailing Address - Street 1:2626 N 76TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-1137
Mailing Address - Country:US
Mailing Address - Phone:414-476-9400
Mailing Address - Fax:414-755-4769
Practice Address - Street 1:2727 N GRANDVIEW BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-6100
Practice Address - Country:US
Practice Address - Phone:262-547-9422
Practice Address - Fax:262-548-0644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LMG INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty