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1295711067

NPI Code Detail

MEDICARE: JOHN LONGANO MD

MEDICARE: JOHN LONGANO MD

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	36059397	IL
2	207R00000X	Internal Medicine Physician	036-059397	IL
3	207P00000X	Emergency Medicine Physician	036-059397	IL

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	:	1295711067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN LONGANO MD

Provider Business Mailing Address
First Line	:	111 E WISCONSIN AVE STE 2000
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-4809
Country	:	US
Telephone Number	:	414-290-6715
Fax Number	:	414-290-6755

Provider Business Practice Location Address
First Line	:	3100 SUPERIOR AVE
Second Line	:
City	:	SHEBOYGAN
State	:	WI
Zip	:	53081-1948
Country	:	US
Telephone Number	:	414-290-6715
Fax Number	:

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	08/23/2022

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Directions to “ JOHN LONGANO MD” Practice Location

Language	Start Address	Practice Location

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