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LAKESHORE MEDICAL CLINIC LLC
NPI 1265597645
Durable Medical Equipment & Medical Supplies in Cudahy, WI

Active since December 26, 2006CLIA 52D0920902 · Waiver
5900 S LAKE DR, CUDAHY, WI 53110(414) 489-4190 Get Directions Write a Review

NPPES record last updated: October 14, 2025. Verified against the NPPES registry weekly; last sync: July 26, 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 1265597645) is a healthcare organization registered as a durable medical equipment & medical supplies in Cudahy, Wisconsin and active in the NPI registry since December 2006. The organization holds a CLIA Waiver certificate valid through October 13, 2026 and lists Kara Richardson, Asst Treasurer, as its authorized official.

NPPES Registry Identity

NPI1265597645
Entity TypeOrganization
Primary Taxonomy332B00000X
Legal Business NameLAKESHORE MEDICAL CLINIC LLC
Location Address5900 S LAKE DRCudahy, WI 53110-3171
Mailing Address5900 S Lake DrCudahy, WI 53110-3171 · (414) 489-4190
Phone(414) 489-4190
Organization SubpartNo
Authorized OfficialKara RichardsonAsst Treasurer · (704) 631-0450
Enumeration DateDecember 26, 2006
Last NPPES UpdateOctober 14, 2025
NPPES CertifiedOctober 14, 2025
✔ NPI 1265597645 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.

5900 S LAKE DR, Cudahy, WI 53110
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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 52D0920902

Lakeshore Medical Clinic-Cudahy Campus · Cudahy, WI
Active · expires Oct 13, 2026
CLIA Number52D0920902
Laboratory TypePhysician Office
Certificate Effective DateOctober 14, 2024
Certificate Expiration DateOctober 13, 2026
Laboratory DirectorDr. Dexter Rebancos
Laboratory Phone(414) 769-4190
Laboratory LocationLakeshore Medical Clinic-Cudahy Campus5900 S Lake Dr, Cudahy, WI 53110
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only 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.

DR. NOEL K GARCHITORENA MD
Psychiatry & Neurology (Geriatric Psychiatry)
5900 S LAKE DR
CUDAHY, WI 53110
Milwaukee County (414) 489-9000
DR. ALLAN RICHARD PASCH MD
Surgery
5900 S LAKE DR
CUDAHY, WI 53110
Milwaukee County (414) 489-4190
AURORA HEALTH CARE METRO, INC.
Pharmacy (Institutional Pharmacy)
5900 S LAKE DR
CUDAHY, WI 53110
Milwaukee County (414) 489-4600
DR. ROM A STEVENS M.D.
Internal Medicine (Critical Care Medicine)
5900 S LAKE DR
CUDAHY, WI 53110
Milwaukee County (414) 489-9000
AMANDA ZAUNER
Physician Assistant
5900 S LAKE DR
CUDAHY, WI 53110
Milwaukee County (414) 489-9000
ASAM KHAN D.O.
Hospitalist
5900 S LAKE DR
CUDAHY, WI 53110
Milwaukee County (414) 689-9000
PULMONARY & CRITICAL CARE ASSOCIATES S C
Clinic/Center (Medical Specialty)
5900 S LAKE DR
CUDAHY, WI 53110
Milwaukee County (414) 744-4000
DR. ARTURO EDUARDO EYZAGUIRRE MD
Internal Medicine (Pulmonary Disease)
5900 S LAKE DR
CUDAHY, WI 53110
Milwaukee County (414) 744-4000

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 1265597645. It was assigned to this organization in the NPPES registry on December 26, 2006.

Where is Lakeshore Medical Clinic LLC located?

Lakeshore Medical Clinic LLC is located at 5900 S Lake Dr, Cudahy, WI 53110. The listed phone number is (414) 489-4190.

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 52D0920902) is associated with this NPI, valid through October 13, 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 with the weekly NPPES data releases published by CMS.