Individual
JOHN MICHAEL DISABATO JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 S EDWARDS BLVD, LAKE GENEVA, WI 53147-4507
(262) 248-3391
(262) 248-3421
Mailing address
551 LEAH LN APT 3F, WOODSTOCK, IL 60098-7194
(815) 341-6243
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12399-040
WI
Other
Enumeration date
10/19/2020
Last updated
10/19/2020
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