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NPI Code Detail

MEDICARE: DR. JOHN RICHARD REISKYTL MD

MEDICARE: DR. JOHN RICHARD REISKYTL 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
1207Q00000XFamily Medicine Physician30968WI

General Provider Information

NPI Number : 1841210150
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN RICHARD REISKYTL MD
Provider Business Mailing Address
First Line : 1205 NORTH AVE
Second Line : CLEVELAND VA CBOC
City : CLEVELAND
State : WI
Zip : 53015-1413
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1205 NORTH AVE
Second Line : CLEVELAND VA CBOC
City : CLEVELAND
State : WI
Zip : 53015-1413
Country : US
Telephone Number : 920-693-5600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2006
Last Update Date : 07/08/2007

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