Bostanche, John L

Bostanche, John L is an individual health care provider with primary practice located at 6123 Green Bay Rd Ste 100, Kenosha WI 53142-2939. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as his primary health care specialty. Bostanche, John L can be contacted via phone (262) 657-3668.

Contact Information

Primary practice address
6123 Green Bay Rd Ste 100 Kenosha WI 53142-2939
Phone: (262) 657-3668
Fax: (262) 652-0564
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 654025 Wisconsin
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 016004510 Illinois

Profile Details

NPI number 1821092420
LBN Legal business name Bostanche, John L
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 10th, 2005
Last updated May 5th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821092420 NPPES
Wisconsin MEDICAID 43215000

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