Healthcare Provider Details

I. General information

NPI: 1558325191
Provider Name (Legal Business Name): JOHN E WHITCOMB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 N 12TH ST
MILWAUKEE WI
53233-1305
US

IV. Provider business mailing address

7071 S 13TH ST STE 104
OAK CREEK WI
53154-1466
US

V. Phone/Fax

Practice location:
  • Phone: 414-219-7880
  • Fax:
Mailing address:
  • Phone: 414-570-7106
  • Fax: 414-570-7136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25743-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: