Healthcare Provider Details

I. General information

NPI: 1528001294
Provider Name (Legal Business Name): JOHN SEBASTIAN PUJALS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN MICHAEL SEBASTIAN PUJALS MD

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 ROCKWOOD LN
NEENAH WI
54956-1983
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 920-725-4100
  • Fax: 920-686-9674
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number42268-020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number42268-20
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number42268-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: