Provider Demographics
NPI:1861690943
Name:GARY M LAMPS MD
Entity type:Organization
Organization Name:GARY M LAMPS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYCISIAN
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAMPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-720-9000
Mailing Address - Street 1:1033 PEMBROOK DR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-4260
Mailing Address - Country:US
Mailing Address - Phone:920-720-9000
Mailing Address - Fax:
Practice Address - Street 1:200 THEDA CLARK MEDICAL PLZ STE 350
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2790
Practice Address - Country:US
Practice Address - Phone:920-720-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23655-020207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB54419Medicare UPIN