LAKESHORE UROLOGY INC (NPI# 1518988484) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518988484 |
| Entity Type | Organization |
| Organization Name | LAKESHORE UROLOGY INC |
| Practice Address |
6308 8th Ave Suite #3040 Kenosha WI 53143-5031 |
| Mailing Address |
6308 8th Ave Suite #105 Kenosha WI 53143-5031 |
| Practice Telephone | 2626562386 |
| Mailing Telephone | 2626562386 |
| Mailing Fax Number | 2626535413 |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2010-08-27 |
| Authorized Official Name | MELINDA KNIGHT (OWNER/PRESIDENT) |
| Authorized Official Telephone | 2626562386 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 34097500 | 05 |
| Street Address |
6308 8TH AVE SUITE #3040 |
| City | KENOSHA |
| State | WI |
| Zip Code | 53143-5031 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366440851 | Janet S Barney | Nurse Practitioner | 6308 8th Ave, Suite 2000, Kenosha, WI 53143-5031 | 2005-07-08 |
| 1669094165 | Simona Slavinskiene | Nurse Practitioner | 6308 8th Ave, Kenosha, WI 53143-5031 | 2020-05-07 |
| 1366063133 | Lisa Neyens | Pharmacist | 6308 8th Ave, Kenosha, WI 53143-5031 | 2020-05-02 |
| 1164056727 | Michael James Church | Physician Assistant | 6308 8th Ave, Kenosha, WI 53143-5031 | 2020-02-23 |
| 1215593009 | Ihc-wound Care Services LLC | Emergency Medicine | 6308 8th Ave, Kenosha, WI 53143-5031 | 2019-05-16 |
| 1609358357 | Samantha M Rhodes | Physical Therapist | 6308 8th Ave, Kenosha, WI 53143-5031 | 2018-08-29 |
| 1063953784 | Megan Roethle | Registered Nurse | 6308 8th Ave, Kenosha, WI 53143-5031 | 2017-03-14 |
| 1043678683 | Sarah Rens | Physician Assistant | 6308 8th Ave, Kenosha, WI 53143-5031 | 2016-02-09 |
| 1922472422 | Catherine A Hernandez | Physician Assistant | 6308 8th Ave, Kenosha, WI 53143-5031 | 2015-11-20 |
| 1750779856 | Elliot M Simon | Physician Assistant | 6308 8th Ave, Suite 1020, Kenosha, WI 53143-5031 | 2014-12-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891262275 | Shanda L Goecks | Registered Nurse | 6916 26th Ave, Kenosha, WI 53143 | 2018-10-24 |
| 1689942989 | Racine Kenosha Community Action Agency | Public Health or Welfare | 2000 63rd Street, Kenosha, WI 53143 | 2011-12-01 |
| 1538497797 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 7525 Sheridan Rd, Kenosha, WI 53143 | 2009-11-30 |
| 1497929012 | Ebba M Johnson | Physical Therapist | 524 74th Street, Kenosha, WI 53143 | 2008-04-15 |
| 1770789489 | Kenosha Community Health Center, Inc | Family Medicine | 6226 14th Ave, Kenosha, WI 53143 | 2007-06-21 |
| 1558413161 | Junith M Thompson | Obstetrics & Gynecology | 6530 Sheridan Road, Kenosha, WI 53143 | 2007-01-17 |
| 1154471332 | Ljh Ambulance, Inc | Ambulance | 6329 28th Ave, Kenosha, WI 53143 | 2007-01-11 |
| 1578625794 | Michael A Schellpfeffer Md Ob Gyn Sc | Obstetrics & Gynecology | 1400 75th Street, Kenosha, WI 53143 | 2006-12-14 |
| 1457468654 | Yasmine S Sido | Physician Assistant | 7550 22nd Ave, Kenosha, WI 53143 | 2006-08-24 |
| 1356307359 | Nancy Jane Houtchens | Dentist | 7533 22nd Ave, Ste 100, Kenosha, WI 53143 | 2006-04-26 |
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| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730404385 | Robert J Hartman Jr. | Urology | 10400 75th St Ste 204, Kenosha, WI 53142-7884 | 2010-04-06 |
| 1558456749 | John C Matteucci Jr. | Urology | 6127 Green Bay Road, Suite 600, Kenosha, WI 53142-2973 | 2006-10-04 |
| 1801080973 | John C Matteucci Jr Md Sc | Urology | 6127 Green Bay Road, Suite 600, Kenosha, WI 53142-2973 | 2007-08-31 |
| 1396831343 | Kenosha Urology Clinic, S.c. | Urology | 6308 8th Ave, Suite 503, Kenosha, WI 53143-5031 | 2006-10-05 |
| 1760413900 | Ned R. Novsam | Urology | 6308 8th Ave, Suite 503, Kenosha, WI 53143-5031 | 2006-07-05 |
| 1134150386 | Meredith Carter Clubb | Urology | 6308 8th Ave, Ste 503, Kenosha, WI 53143-5031 | 2006-07-05 |
| 1629032115 | Harry M Matschke | Urology | 10400 75th St, Kenosha, WI 53142-7884 | 2006-04-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649520180 | George Leonard Apfelbach Jr. | Urology | 4098 Main St, Fish Creek, WI 54212-0067 | 2012-09-12 |
| 1346505708 | Kenneth Lowell Day | Urology | 2603 Teal Ave (residence), Wausau, WI 54401-7162 | 2012-07-11 |
| 1356601587 | Fox Valley Urological Associates Sc | Urology | 2700 E Enterprise Ave Ste A, Appleton, WI 54913-7656 | 2012-05-22 |
| 1730445255 | Anand Patel | Urology | 2424 S 90th St Fl 3, West Allis, WI 53227-2455 | 2012-04-10 |
| 1831486117 | Mary Hallman Leikness | Urology | 358 S. Oxford Street, Pob 207, Wautoma, WI 54982-0000 | 2011-07-07 |
| 1710293105 | Charles Copland Smith | Urology | 674 Sunset Circle, Green Bay, WI 54301 | 2010-08-24 |
| 1689991200 | Sean Brady Mcadams | Urology | 720 S Vanburen Street, Suite 301, Green Bay, WI 54301 | 2010-04-21 |
| 1588998538 | Gary Melvin Licklider | Urology | 5002 Prairie Rose Ct, Middleton, WI 53562-2385 | 2009-09-23 |
| 1376793240 | Raymond Harkavy | Urology | 9440 N. Broadmoor Road, Milwaukee, WI 53217-1309 | 2008-09-26 |
| 1356591978 | Randle E Pollard | Urology | 1233 N. Marshall St., #274, Milwaukee, WI 53202 | 2008-09-19 |
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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.