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NPI Code Detail

MEDICARE: JOHN HERLACHE MD

MEDICARE: JOHN HERLACHE 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
1174400000XSpecialist16753WI

General Provider Information

NPI Number : 1801053319
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN HERLACHE MD
Provider Business Mailing Address
First Line : 1843 MICHIGAN ST
Second Line :
City : STURGEON BAY
State : WI
Zip : 54235-1007
Country : US
Telephone Number : 920-746-1060
Fax Number : 920-746-1072
Provider Business Practice Location Address
First Line : 1843 MICHIGAN ST
Second Line :
City : STURGEON BAY
State : WI
Zip : 54235-1007
Country : US
Telephone Number : 920-746-1060
Fax Number : 920-746-1072
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2008
Last Update Date : 05/21/2008

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Directions to “ JOHN HERLACHE MD” Practice Location

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