MEDICARE: JOHN LADISA

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	2472B0301X	Biomedical Engineering Technician

General Provider Information

NPI Number	:	1780007831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN LADISA

Provider Business Mailing Address
First Line	:	1637 W. WISCONSIN AVE
Second Line	:	ROOM 311
City	:	MILWAUKEE
State	:	WI
Zip	:	53233
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1637 W. WISCONSIN AVE
Second Line	:	ROOM 311
City	:	MILWAUKEE
State	:	WI
Zip	:	53233
Country	:	US
Telephone Number	:	414-288-6739
Fax Number	:

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

Provider Enumeration Date	:	01/27/2014
Last Update Date	:	01/27/2014

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