Individual
DR. JOHN L BOSTANCHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
6123 GREEN BAY RD, STE 100, KENOSHA, WI 53142-2939
(262) 657-3668
(262) 652-0564
Mailing address
6123 GREEN BAY RD, STE 100, KENOSHA, WI 53142-2939
(262) 657-3668
(262) 652-0564
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
016004510
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
654025
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43215000
—
WI
Enumeration date
06/10/2005
Last updated
05/05/2010
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