Healthcare Provider Details

I. General information

NPI: 1407751688
Provider Name (Legal Business Name): JOHN UEBELACKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 E WILSON ST
MILWAUKEE WI
53207-1635
US

IV. Provider business mailing address

N53W37134 WASHINGTON ST
OCONOMOWOC WI
53066-3151
US

V. Phone/Fax

Practice location:
  • Phone: 414-264-2355
  • Fax:
Mailing address:
  • Phone: 262-894-1173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number54934
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1123516-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: