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General NPI Number Information
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NPI Number | 1316409196
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Entity Type | Individual
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Provider Name | JACK M MASSEE DO
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Gender | Male
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 707 14TH ST
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City | BARABOO
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State | WI
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Zip | 53913-1539
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Country | US
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Telephone | 608-356-1400
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Fax | 608-355-7007
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Provider Business Mailing Address
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Address Line | 1808 W BETLINE HWY
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City | MADISON
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State | WI
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Zip | 53713-2334
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Country | US
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Telephone | 608-280-4647
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Fax | 608-250-1384
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 75006-21
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License Number State | WI
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