Individual
JAN M MATOUSEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
111 E WISCONSIN AVE, MILWAUKEE, WI 53202-4815
(414) 290-6720
(414) 290-6755
Mailing address
111 E WISCONSIN AVE, MILWAUKEE, WI 53202-4815
(414) 290-6720
(414) 290-6755
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
32212-021
WI
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
32212-21
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30051100
—
WI
01
—
930044468
MEDICARE RAILROAD
WI
Enumeration date
06/24/2006
Last updated
03/07/2013
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