MEDICARE: JOHN MATTHEW WYSOCKI JD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	RQ411071	OH

General Provider Information

NPI Number	:	1780516229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN MATTHEW WYSOCKI JD

Provider Business Mailing Address
First Line	:	1370 LOG POND DR APT 202
Second Line	:
City	:	NEWARK
State	:	OH
Zip	:	43055-0010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1370 LOG POND DR APT 202
Second Line	:
City	:	NEWARK
State	:	OH
Zip	:	43055-0010
Country	:	US
Telephone Number	:	740-405-4869
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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