MEDICARE: JOHN M ELISBERG, 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
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1972550093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN M ELISBERG, MD

Provider Business Mailing Address
First Line	:	PO BOX 2123
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54912-2123
Country	:	US
Telephone Number	:	920-451-8142
Fax Number	:

Provider Business Practice Location Address
First Line	:	169 E NORTH WATER ST
Second Line	:
City	:	NEENAH
State	:	WI
Zip	:	54956-2708
Country	:	US
Telephone Number	:	920-451-8142
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN M ELISBERG
Credential	:	MD
Telephone Number	:	920-451-8142

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	08/22/2020

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