MEDICARE: MR. JOHN STANLEY MISHASEK CPED

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	225000000X	Orthotic Fitter

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	:	1528136777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN STANLEY MISHASEK CPED

Provider Business Mailing Address
First Line	:	2415 N UNION BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1107
Country	:	US
Telephone Number	:	719-632-4275
Fax Number	:	719-471-0760

Provider Business Practice Location Address
First Line	:	2415 N UNION BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1107
Country	:	US
Telephone Number	:	719-632-4275
Fax Number	:	719-471-0760

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/09/2007

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