Individual
JOHN L UNDERWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
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
036-058610
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036058610
—
IL
01
—
551520697
TRICARE NORTH REGION
—
01
—
P00056201
MEDICARE RAILROAD
IL
Enumeration date
07/25/2006
Last updated
01/30/2009
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