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LAKESHORE MEDICAL CLINIC LLC
NPI 1154840163
Durable Medical Equipment & Medical Supplies in Oak Creek, WI

Active since September 12, 2017CLIA 52D0920903 · Microscopy
200 E RYAN RD, OAK CREEK, WI 53154(414) 570-3590(414) 570-3599 Get Directions Write a Review

NPPES record last updated: October 14, 2025. Verified against the NPPES registry weekly; last sync: August 09, 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 1154840163) is a healthcare organization registered as a durable medical equipment & medical supplies in Oak Creek, Wisconsin and active in the NPI registry since September 2017. The organization holds a CLIA Microscopy certificate valid through August 5, 2027 and lists Kara Richardson, Asst Treasurer, as its authorized official.

NPPES Registry Identity

NPI1154840163
Entity TypeOrganization
Primary Taxonomy332B00000X
Legal Business NameLAKESHORE MEDICAL CLINIC LLC
Location Address200 E RYAN RDOak Creek, WI 53154-4563
Mailing Address3301 W Forest Home AveMilwaukee, WI 53215-2843 · (414) 647-6326
Phone(414) 570-3590
Fax(414) 570-3599
Organization SubpartNo
Authorized OfficialKara RichardsonAsst Treasurer · (704) 631-0450
Enumeration DateSeptember 12, 2017
Last NPPES UpdateOctober 14, 2025
NPPES CertifiedOctober 14, 2025
✔ NPI 1154840163 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.
200 E RYAN RD, Oak Creek, WI 53154
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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 for Provider-Performed Microscopy Procedures (PPMP) 52D0920903

Lakeshore Medical Clinic - Oak Creek · Oak Creek, WI
Active · expires Aug 5, 2027
CLIA Number52D0920903
Laboratory TypePhysician Office
Certificate Effective DateAugust 6, 2025
Certificate Expiration DateAugust 5, 2027
Laboratory DirectorDr. Shereen Mohis
Laboratory Phone(414) 570-3590
Laboratory LocationLakeshore Medical Clinic - Oak Creek200 E Ryan, Oak Creek, WI 53154
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 20

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

KELSEY KUJELLIS PA
Physician Assistant
200 E RYAN RD
OAK CREEK, WI 53154
Milwaukee County (414) 570-3590
GREGG E TETTING MD
Pediatrics
200 E RYAN RD
OAK CREEK, WI 53154
Milwaukee County (414) 570-3590
SHEREEN MOHIS M.D.
Family Medicine
200 E RYAN RD
OAK CREEK, WI 53154
Milwaukee County (414) 570-3590
DR. AGNES PROSPERE MD
Family Medicine
200 E RYAN RD
OAK CREEK, WI 53154
Milwaukee County (414) 570-3590
WENDI A QUENTIN PT
Physical Therapist
200 E RYAN RD
OAK CREEK, WI 53154
Milwaukee County (414) 570-3590
EMILY RUTH JAEGER MD
Psychiatry & Neurology (Neurology)
200 E RYAN RD
OAK CREEK, WI 53154
Milwaukee County (414) 570-3590
DR. NABILA QUADRI M.D.
Emergency Medicine
200 E RYAN RD
OAK CREEK, WI 53154
Milwaukee County (414) 570-3590
HUI ZHANG
Orthopaedic Surgery (Foot and Ankle Surgery)
200 E RYAN RD
OAK CREEK, WI 53154
Milwaukee County (414) 570-3590

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 1154840163. It was assigned to this organization in the NPPES registry on September 12, 2017.

Where is Lakeshore Medical Clinic LLC located?

Lakeshore Medical Clinic LLC is located at 200 E Ryan Rd, Oak Creek, WI 53154. The listed phone number is (414) 570-3590.

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 for Provider-Performed Microscopy Procedures (PPMP) (number 52D0920903) is associated with this NPI, valid through August 5, 2027. 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 9 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.