Provider Demographics
NPI:1538127949
Name:LAL, ALYSANDRA (MD)
Entity type:Individual
Prefix:
First Name:ALYSANDRA
Middle Name:
Last Name:LAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALYSANDRA
Other - Middle Name:
Other - Last Name:SCHWARZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:788 N JEFFERSON ST
Mailing Address - Street 2:SUITE 300/KAAREN BUTZEN
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3718
Mailing Address - Country:US
Mailing Address - Phone:414-272-8950
Mailing Address - Fax:414-272-0859
Practice Address - Street 1:2350 N LAKE DRIVE
Practice Address - Street 2:SUITE 304
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211
Practice Address - Country:US
Practice Address - Phone:414-298-7227
Practice Address - Fax:414-298-7229
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48299208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1538127949Medicaid
WI1538127949Medicaid
WI736450061Medicare PIN