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NPI Code Detail

MEDICARE: MR. JAMES TEWELES SHLIMOVITZ LAT

MEDICARE: MR. JAMES TEWELES SHLIMOVITZ LAT
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
12255A2300XAthletic Trainer43-039WI

General Provider Information

NPI Number : 1205828613
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES TEWELES SHLIMOVITZ LAT
Provider Business Mailing Address
First Line : 515 OAKRIDGE DR
Second Line :
City : PORTAGE
State : WI
Zip : 53901-1219
Country : US
Telephone Number : 608-742-8470
Fax Number :
Provider Business Practice Location Address
First Line : 707 14TH ST
Second Line :
City : BARABOO
State : WI
Zip : 53913-1539
Country : US
Telephone Number : 608-356-1478
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2005
Last Update Date : 09/24/2015

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