Healthcare Provider Details

I. General information

NPI: 1942822374
Provider Name (Legal Business Name): JACOB WOCHNA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 PARK AVE
COLUMBUS WI
53925-2402
US

IV. Provider business mailing address

1515 PARK AVE
COLUMBUS WI
53925-2402
US

V. Phone/Fax

Practice location:
  • Phone: 920-623-2200
  • Fax:
Mailing address:
  • Phone: 920-623-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOT020025
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number82125-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: