MEDICARE: JOHN STECH DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	44094	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184704108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN STECH DO

Provider Business Mailing Address
First Line	:	4425 N PORT WASHINGTON RD
Second Line	:	ATTN: CLINIC CREDENTIALING
City	:	GLENDALE
State	:	WI
Zip	:	53212-1082
Country	:	US
Telephone Number	:	414-270-4932
Fax Number	:

Provider Business Practice Location Address
First Line	:	2320 N LAKE DR
Second Line	:	ROOM 3603
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-4507
Country	:	US
Telephone Number	:	414-270-4932
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	05/25/2011

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