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NPI Code Detail

MEDICARE: JOHN MICHAEL DISABATO JR.

MEDICARE: JOHN MICHAEL DISABATO JR.
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
1183500000XPharmacist12399-040WI

General Provider Information

NPI Number : 1538768957
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN MICHAEL DISABATO JR.
Provider Business Mailing Address
First Line : 551 LEAH LN APT 3F
Second Line :
City : WOODSTOCK
State : IL
Zip : 60098-7194
Country : US
Telephone Number : 815-341-6243
Fax Number :
Provider Business Practice Location Address
First Line : 201 S EDWARDS BLVD
Second Line :
City : LAKE GENEVA
State : WI
Zip : 53147-4507
Country : US
Telephone Number : 262-248-3391
Fax Number : 262-248-3421
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2020
Last Update Date : 10/19/2020

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Directions to “ JOHN MICHAEL DISABATO JR. ” Practice Location

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