Individual
JOHN C MATTEUCCI JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6127 GREEN BAY ROAD, SUITE 600, KENOSHA, WI 53142-2973
(262) 653-9221
(262) 653-9229
Mailing address
6127 GREEN BAY ROAD, SUITE 600, KENOSHA, WI 53142-2973
(262) 653-9221
(262) 653-9229
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
01083818A
IN
208800000X
Urology Physician
Primary
38866
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300037445
—
IN
05
—
32467300
—
WI
Enumeration date
10/04/2006
Last updated
04/15/2024
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