Provider Demographics
NPI:1386903151
Name:PILOCZEWSKI, LAWRENCE (LAC, MSOM)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:PILOCZEWSKI
Suffix:
Gender:M
Credentials:LAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 W LAYTON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4563
Mailing Address - Country:US
Mailing Address - Phone:414-727-4640
Mailing Address - Fax:
Practice Address - Street 1:10945 N PORT WASHINGTON RD
Practice Address - Street 2:STE 210
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5078
Practice Address - Country:US
Practice Address - Phone:262-240-0001
Practice Address - Fax:262-240-0030
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI691-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist