| Lakeside Neurocare Limited | |
|
2700 W 9th Ave Ste 225 Oshkosh WI 54904-7865 | |
| (920) 223-5580 | |
| (920) 223-5592 |
| Full Name | Lakeside Neurocare Limited |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2700 W 9th Ave Ste 225, Oshkosh, Wisconsin |
| Authorized Official Name and Position | Susan M Golden (BUSINESS MANAGER) |
| Authorized Official Contact | 9202235582 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Neurocare Limited 2700 W 9th Ave Ste 225 Oshkosh WI 54904-7865 Ph: (920) 223-5580 | Lakeside Neurocare Limited 2700 W 9th Ave Ste 225 Oshkosh WI 54904-7865 Ph: (920) 223-5580 |
| NPI Number | 1710046404 |
|---|---|
| Provider Enumeration Date | 12/08/2006 |
| Last Update Date | 04/13/2012 |
| Medicare PECOS PAC ID | 9032161443 |
|---|---|
| Medicare Enrollment ID | O20050214000860 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710046404 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Xian Feng Gu |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1811935752 PECOS PAC ID: 7911959325 Enrollment ID: I20050214000877 |
| Provider Name | Mark T Szmanda |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1912060971 PECOS PAC ID: 1658323720 Enrollment ID: I20050216000914 |
| Provider Name | Victor A Diaz-cotrina |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1235195744 PECOS PAC ID: 1052411741 Enrollment ID: I20070710000947 |
| Provider Name | Renae M Patrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750719050 PECOS PAC ID: 7517196868 Enrollment ID: I20140206001489 |
| Provider Name | Lacy B Ihde |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265847305 PECOS PAC ID: 8123341138 Enrollment ID: I20141224000719 |
Lakeside Neurocare Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 855 N Westhaven Dr, Oshkosh, WI 54904 Phone: 920-223-5580 Fax: 920-223-3580 | |
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