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General NPI Number Information
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NPI Number | 1699737288
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Entity Type | Individual
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Provider Name | JACOB R. DINAUER MED, ATC, EMT
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Gender | Male
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2001 ALFORD PARK DR TARC 1150
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City | KENOSHA
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State | WI
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Zip | 53140-1929
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Country | US
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Telephone | 262-551-6107
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Fax | 262-551-5995
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Provider Business Mailing Address
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Address Line | 3526 W 7 MILE RD
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City | CALEDONIA
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State | WI
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Zip | 53108-9749
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Country | US
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Telephone | 262-939-6560
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Fax | 262-551-5995
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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 | 146M00000X
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Taxonomy Name | Intermediate Emergency Medical Technician
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License Number | 304299
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 103-039
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License Number State | WI
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