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LAKESHORE MEDICAL CLINIC, LLC
NPI 1114087053
Durable Medical Equipment & Medical Supplies in South Milwaukee, WI

Active since December 11, 2006CLIA 52D0980686 · Waiver
3611 S CHICAGO AVE, SOUTH MILWAUKEE, WI 53172(414) 762-7270(414) 762-7864 Get Directions Write a Review

NPPES record last updated: October 14, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Lakeshore Medical Clinic, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKESHORE MEDICAL CLINIC, LLC (NPI 1114087053) is a healthcare organization registered as a durable medical equipment & medical supplies in South Milwaukee, Wisconsin and active in the NPI registry since December 2006. The organization holds a CLIA Waiver certificate valid through November 29, 2026 and lists Kara Richardson, Asst Treasurer, as its authorized official.

NPPES Registry Identity

NPI1114087053
Entity TypeOrganization
Primary Taxonomy332B00000X
Legal Business NameLAKESHORE MEDICAL CLINIC, LLC
Location Address3611 S CHICAGO AVESouth Milwaukee, WI 53172-3708
Mailing Address3611 S Chicago AveSouth Milwaukee, WI 53172-3738 · (414) 762-7270 · Fax (414) 762-7864
Phone(414) 762-7270
Fax(414) 762-7864
Organization SubpartNo
Authorized OfficialKara RichardsonAsst Treasurer · (704) 631-0450
Enumeration DateDecember 11, 2006
Last NPPES UpdateOctober 14, 2025
NPPES CertifiedOctober 14, 2025
✔ NPI 1114087053 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDurable Medical Equipment & Medical SuppliesSuppliers
Taxonomy Code332B00000X
Definition
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.
3611 S CHICAGO AVE, South Milwaukee, WI 53172
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 52D0980686

Lakeshore Medical Clinic - South Milwaukee · South Milwaukee, WI
Active · expires Nov 29, 2026
CLIA Number52D0980686
Laboratory TypePhysician Office
Certificate Effective DateNovember 30, 2024
Certificate Expiration DateNovember 29, 2026
Laboratory DirectorDr. Sandhya Sureddi
Laboratory Phone(414) 762-7270
Laboratory LocationLakeshore Medical Clinic - South Milwaukee3611 S Chicago Ave, South Milwaukee, WI 53172
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SANDHYA SUREDDI MD
Internal Medicine
3611 S CHICAGO AVE
SOUTH MILWAUKEE, WI 53172
Milwaukee County (414) 762-7270
DR. JILL C LYONS DPT
Physical Therapist
3611 S CHICAGO AVE, SUTIE 120
SOUTH MILWAUKEE, WI 53172
Milwaukee County (414) 766-2440
MADELINE PRESTON OTD
Occupational Therapist
3611 S CHICAGO AVE
SOUTH MILWAUKEE, WI 53172
Milwaukee County (414) 766-2440
JOHN P VIEAU PA
Physician Assistant (Medical)
3611 S CHICAGO AVE
SOUTH MILWAUKEE, WI 53172
Milwaukee County (414) 762-7270
CASSANDRA MARASCH DPT
Physical Therapist
3611 S CHICAGO AVE
SOUTH MILWAUKEE, WI 53172
Milwaukee County (414) 766-2440
DREW GUNDERSON MD
Family Medicine
3611 S CHICAGO AVE
SOUTH MILWAUKEE, WI 53172
Milwaukee County (414) 762-7270
KATIE J RASMUSSEN PA-C
Physician Assistant
3611 S CHICAGO AVE
SOUTH MILWAUKEE, WI 53172
Milwaukee County (414) 762-7270
DR. JILLIAN HUYCK HUDSON MD
Family Medicine
3611 S CHICAGO AVE, SUITE 100
SOUTH MILWAUKEE, WI 53172
Milwaukee County (414) 762-7270

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lakeshore Medical Clinic, LLC's NPI number?

The NPI number for Lakeshore Medical Clinic, LLC is 1114087053. It was assigned to this organization in the NPPES registry on December 11, 2006.

Where is Lakeshore Medical Clinic, LLC located?

Lakeshore Medical Clinic, LLC is located at 3611 S Chicago Ave, South Milwaukee, WI 53172. The listed phone number is (414) 762-7270.

What is Lakeshore Medical Clinic, LLC's specialty?

The primary specialty registered for this NPI is Durable Medical Equipment & Medical Supplies with taxonomy code 332B00000X.

Does Lakeshore Medical Clinic, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 52D0980686) is associated with this NPI, valid through November 29, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Lakeshore Medical Clinic, LLC was last updated on October 14, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.