JOHN C MATTEUCCI JR MD SC (NPI# 1801080973) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801080973 |
| Entity Type | Organization |
| Organization Name | JOHN C MATTEUCCI JR MD SC |
| Practice Address |
6127 Green Bay Road Suite 600 Kenosha WI 53142-2973 |
| Practice Telephone | 2626539221 |
| Practice Fax Number | 2626539229 |
| Mailing Telephone | 2626539221 |
| Mailing Fax Number | 2626539229 |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2007-08-31 |
| Authorized Official Name | JOHN C MATTEUCCI JR. (PRESIDENT) |
| Authorized Official Telephone | 2626539221 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | Allopathic & Osteopathic Physicians |
| Street Address |
6127 GREEN BAY ROAD SUITE 600 |
| City | KENOSHA |
| State | WI |
| Zip Code | 53142-2973 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558456749 | John C Matteucci Jr. | Urology | 6127 Green Bay Road, Suite 600, Kenosha, WI 53142-2973 | 2006-10-04 |
| 1104131960 | Green Bay Road Medical Services Inc | Clinic/Center | 6127 Green Bay Road, Suite 600, Kenosha, WI 53142-2930 | 2010-08-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588297816 | Caring Hearts Home Health Care | In Home Supportive Care | 6021-57th Ave, Suite C103, Kenosha, WI 53142 | 2020-02-14 |
| 1144785395 | Michael L Wrzesinski | Counselor | 4109 67th Street, Kenosha, WI 53142 | 2019-02-01 |
| 1720538499 | David Smith | Counselor | 10900 67th Street, Kenosha, WI 53142 | 2016-10-06 |
| 1326404641 | Smile Doctors Ltd | Dentist | 7003 39th Ave, Kenosha, WI 53142 | 2016-01-04 |
| 1225409485 | Antonia Marie Decker | Physician Assistant | 10400 75th St. Ste 204, Kenosha, WI 53142 | 2015-10-14 |
| 1780060582 | Joshua Haas | Pharmacist | 7701 Green Bay Road, Kenosha, IL 53142 | 2015-08-04 |
| 1811379225 | Dana Mary Stout | Registered Nurse | 7401 104th Avenue, Suite 110, Comprehensive Orthopaedics, S.c., Kenosha, WI 53142 | 2015-06-22 |
| 1669815569 | Joshua Knute Elson | Radiology | 6811 118th Ave, Kenosha, WI 53142 | 2013-04-10 |
| 1356610166 | Michael J Gallo | Pharmacist | 7535 North Greenbay Rd, Kenosha, WI 53142 | 2011-12-22 |
| 1720357999 | Orest Carnevale | Registered Nurse | 7316 155th Ct, Kenosha, WI 53142 | 2011-12-18 |
| Find all providers in zip 53142 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730404385 | Robert J Hartman Jr. | Urology | 10400 75th St Ste 204, Kenosha, WI 53142-7884 | 2010-04-06 |
| 1558456749 | John C Matteucci Jr. | Urology | 6127 Green Bay Road, Suite 600, Kenosha, WI 53142-2973 | 2006-10-04 |
| 1396831343 | Kenosha Urology Clinic, S.c. | Urology | 6308 8th Ave, Suite 503, Kenosha, WI 53143-5031 | 2006-10-05 |
| 1518988484 | Lakeshore Urology Inc | Urology | 6308 8th Ave, Suite #3040, Kenosha, WI 53143-5031 | 2006-07-23 |
| 1760413900 | Ned R. Novsam | Urology | 6308 8th Ave, Suite 503, Kenosha, WI 53143-5031 | 2006-07-05 |
| 1134150386 | Meredith Carter Clubb | Urology | 6308 8th Ave, Ste 503, Kenosha, WI 53143-5031 | 2006-07-05 |
| 1629032115 | Harry M Matschke | Urology | 10400 75th St, Kenosha, WI 53142-7884 | 2006-04-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649520180 | George Leonard Apfelbach Jr. | Urology | 4098 Main St, Fish Creek, WI 54212-0067 | 2012-09-12 |
| 1346505708 | Kenneth Lowell Day | Urology | 2603 Teal Ave (residence), Wausau, WI 54401-7162 | 2012-07-11 |
| 1356601587 | Fox Valley Urological Associates Sc | Urology | 2700 E Enterprise Ave Ste A, Appleton, WI 54913-7656 | 2012-05-22 |
| 1730445255 | Anand Patel | Urology | 2424 S 90th St Fl 3, West Allis, WI 53227-2455 | 2012-04-10 |
| 1831486117 | Mary Hallman Leikness | Urology | 358 S. Oxford Street, Pob 207, Wautoma, WI 54982-0000 | 2011-07-07 |
| 1710293105 | Charles Copland Smith | Urology | 674 Sunset Circle, Green Bay, WI 54301 | 2010-08-24 |
| 1689991200 | Sean Brady Mcadams | Urology | 720 S Vanburen Street, Suite 301, Green Bay, WI 54301 | 2010-04-21 |
| 1588998538 | Gary Melvin Licklider | Urology | 5002 Prairie Rose Ct, Middleton, WI 53562-2385 | 2009-09-23 |
| 1376793240 | Raymond Harkavy | Urology | 9440 N. Broadmoor Road, Milwaukee, WI 53217-1309 | 2008-09-26 |
| 1356591978 | Randle E Pollard | Urology | 1233 N. Marshall St., #274, Milwaukee, WI 53202 | 2008-09-19 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.