MEDICARE: JOHN P VIEAU PA

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	363AM0700X	Medical Physician Assistant	240-023	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	:	1295837193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN P VIEAU PA

Provider Business Mailing Address
First Line	:	100 15TH AVE
Second Line	:	#180
City	:	SOUTH MILWAUKEE
State	:	WI
Zip	:	53172-1160
Country	:	US
Telephone Number	:	414-762-7270
Fax Number	:	414-762-4225

Provider Business Practice Location Address
First Line	:	3611 S CHICAGO AVE
Second Line	:
City	:	SOUTH MILWAUKEE
State	:	WI
Zip	:	53172-3738
Country	:	US
Telephone Number	:	414-762-7270
Fax Number	:	414-762-7864

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	12/06/2021

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