EDWARD LAKE (NPI# 1336131101) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336131101 |
| Entity Type | Individual |
| Full Name | EDWARD LAKE |
| Credential | MD |
| Practice Address |
855 N Westhaven Dr Oshkosh WI 54904-7668 |
| Practice Telephone | 9203035626 |
| Practice Fax Number | 9203035632 |
| Mailing Telephone | 9203038700 |
| Mailing Fax Number | 9203035632 |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2017-10-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
29465 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 31925100 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427319409 | Edward Lake | Psychologist | 39 Lewis St, Ballston Spa, NY 12020-1925 | 2012-06-06 |
| 1790820587 | Edward William Lake | Dentist | 313 E High St, Potosi, MO 63664-1924 | 2007-02-20 |
| 1962456822 | Edward C. Lake Jr. | Obstetrics & Gynecology | 235 E Chicago St, Coldwater, MI 49036-1783 | 2006-05-22 |
| Street Address |
855 N WESTHAVEN DR |
| City | OSHKOSH |
| State | WI |
| Zip Code | 54904-7668 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316942212 | Jeffrey H Goldman | Internal Medicine | 855 N Westhaven Dr, Oshkosh, WI 54904-7668 | 2005-06-16 |
| 1336766971 | Jason R Schultz | Nurse Anesthetist, Certified Registered | 855 N Westhaven Dr, Oshkosh, WI 54904-7668 | 2020-06-30 |
| 1437771078 | Kyle Rozek | Physical Therapy Assistant | 855 N Westhaven Dr, Oshkosh, WI 54904-7668 | 2020-05-16 |
| 1447870050 | Inshirah V Robinson | Nurse Anesthetist, Certified Registered | 855 N Westhaven Dr, Oshkosh, WI 54904-7668 | 2020-04-23 |
| 1902433022 | Paige Weigandt | Massage Therapist | 855 N Westhaven Dr, Oshkosh, WI 54904-7668 | 2020-03-26 |
| 1700418944 | Michelle Hill | Pharmacist | 855 N Westhaven Dr, Oshkosh, WI 54904-7668 | 2020-02-05 |
| 1306483854 | Ashley Rose Heesacker | Physician Assistant | 855 N Westhaven Dr, Oshkosh, WI 54904-7668 | 2019-12-03 |
| 1730730730 | Brittany L Hood | Nurse Anesthetist, Certified Registered | 855 N Westhaven Dr, Oshkosh, WI 54904-7668 | 2019-09-23 |
| 1821645391 | Jenna Rose Daun | Physical Therapist | 855 N Westhaven Dr, Oshkosh, WI 54904-7668 | 2019-08-20 |
| 1659928141 | Troy Mcgilligan | Physical Therapist | 855 N Westhaven Dr, Oshkosh, WI 54904-7668 | 2019-08-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326567140 | Mary Kay Benotsch | Registered Nurse | 505 South Washburn Street, Oshkosh, WI 54904 | 2017-09-13 |
| 1295278356 | Braden Williams | Nurse Anesthetist, Certified Registered | 955 Pheasant Creek Dr, Oshkosh, WI 54904 | 2016-11-22 |
| 1740651330 | Ams of Wisconsin - Oshkosh | Clinic/Center | 595 South Washburn St, Oshkosh, WI 54904 | 2015-10-08 |
| 1174990253 | Kaochi Desjheannette Vang | Occupational Therapist | Aurora Medical Center of Oshkosh - Rehab, 855 N. Westhaven Drive, Oshkosh, WI 54904 | 2015-08-25 |
| 1326453200 | Chey V Collura | Surgery | 2700 W 9th Ave Ste 310, Oshkosh, WI 54904 | 2014-06-30 |
| 1275847543 | Eden Rehabilitation Suites and Green House Homes, Inc. | Skilled Nursing Facility | 3151 Eden Court, Oshkosh, WI 54904 | 2010-07-29 |
| 1700043502 | Eric Koehler | Physical Therapist | 3475 Omro Rd Ste 300, Oshkosh, WI 54904 | 2008-05-20 |
| 1831396167 | Angela Marie Wade | Behavioral Analyst | 2986 Fitchburg Ct., Oshkosh, WI 54904 | 2007-06-29 |
| 1174642383 | Michael Gerard Bell | Dentist | 1795 West Pointe Dr, Oshkosh, WI 54904 | 2007-03-28 |
| 1235253030 | Jessica Anne Bielmeier | Registered Nurse | 2700 West 9th Ave #125, Oshkosh, WI 54904 | 2007-03-19 |
| Find all providers in zip 54904 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093916595 | Rafal G Ciecierski | Internal Medicine | 855 N Westhaven Dr, Oshkosh, WI 54904-7668 | 2007-05-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841823390 | Kelby Roholt | Internal Medicine | 305 E Mahn Ct, Oak Creek, WI 53154-2101 | 2020-02-12 |
| 1477186922 | Sydney Kemps | Internal Medicine | 507 N 17th St, Milwaukee, WI 53233-5495 | 2020-02-12 |
| 1053708511 | Rishi Kora | Internal Medicine | 5650 N Green Bay Ave Ste 210, Glendale, WI 53209-4447 | 2015-04-22 |
| 1841523818 | Sana Waheed | Internal Medicine | 301 S Yellowstone Dr Apt 306, Madison, WI 53705-4378 | 2009-09-09 |
| 1841426798 | Wisconsin Vascular Access and Nephrology | Internal Medicine | 1962 N Prospect Ave # 310, Milwaukee, WI 53202-1414 | 2009-06-05 |
| 1184865099 | Zurab Albekioni | Internal Medicine | 3000 Westhill Dr Ste 108, Wausau, WI 54401-3795 | 2009-03-23 |
| 1104095017 | Mark Y Nunag | Internal Medicine | 2050 Continential Drive, West Bend, WI 53095 | 2008-02-25 |
| 1649448259 | Crystalkinetics, LLC | Internal Medicine | 4113 N Lake Dr, Shorewood, WI 53211-1720 | 2008-02-16 |
| 1699975193 | Dawn Wolfgram | Internal Medicine | 5000 W National Ave # Cc-111k, Milwaukee, WI 53295-1000 | 2007-07-23 |
| 1366657710 | Deepak Sharma | Internal Medicine | 7797 W Appletone Ave, Milwaukee, WI 53222 | 2007-05-11 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.