Individual
DR. JONATHAN TYLER LAACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3400 MINISTRY PKWY, WESTON, WI 54476-5220
(715) 393-3000
Mailing address
3400 MINISTRY PKWY, WESTON, WI 54476-5220
(715) 393-3000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
5101020493
MI
207P00000X
Emergency Medicine Physician
Primary
67074
WI
Other
Enumeration date
05/22/2013
Last updated
07/21/2022
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