Individual
DR. J CHANNING TASSONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9000 W WISCONSIN AVE, PEDIATRIC ORTHOPAEDIC SURGERY, MILWAUKEE, WI 53226-4874
(414) 337-7320
(414) 337-7337
Mailing address
9000 W WISCONSIN AVE, PEDIATRIC ORTHOPAEDIC SURGERY, MILWAUKEE, WI 53226-4874
(414) 337-7320
(414) 337-7337
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
39164
WI
207XP3100X
Pediatric Orthopaedic Surgery Physician
39164
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004000261T
HUMANA
—
05
—
1629022546
—
WI
Enumeration date
05/22/2006
Last updated
09/06/2024
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