John L Bostanche (NPI# 1821092420, PAC ID# 4385611490) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PODIATRY.
| Nation Provider ID (NPI) | 1821092420 |
| PAC ID by PECOS | 4385611490 |
| Professional Enrollment ID | I20040917000093 |
| Full Name | John L Bostanche |
| Organization Legal Name | GREAT LAKES FOOT AND ANKLE CENTERS INC |
| Address |
6123 Green Bay Rd Suite 100 Kenosha WI 53142-2939 |
| Phone Number | 2626533668 |
| Gender | M |
| Credential | DPM |
| Medical School | DR. WILLIAM M. SCHOLL COLLEGE OF PODIATRIC MEDICINE |
| Graduation Year | 1990 |
| Primary Specialty | PODIATRY |
| Group Practice PAC ID | 4789651894 |
| Number of Group Practice Members | 2 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 520189 | AURORA MEDICAL CENTER KENOSHA |
| Address | Phone | Organization |
|---|---|---|
| 6123 Green Bay Rd, Suite 100, Kenosha, WI 53142-2939 | 2626533668 | GREAT LAKES FOOT AND ANKLE CENTERS INC |
| Organization Legal Name | GREAT LAKES FOOT AND ANKLE CENTERS INC |
| Physicians | 2 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Paul T Basile | Podiatry | Great Lakes Foot and Ankle Centers Inc | 6123 Green Bay Rd, Suite 100, Kenosha, WI 53142-2939 |
| Street Address |
6123 GREEN BAY RD SUITE 100 |
| City | KENOSHA |
| State | WI |
| Zip | 53142-2939 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Rodrigo B Mata Iii | Internal Medicine | 6123 Green Bay Rd, Suite 120, Kenosha, WI 53142-2927 | |
| Nancy Guadagno | Clinical Social Worker | 6123 Green Bay Rd, Suite 240, Kenosha, WI 53142-2927 | |
| Paul T Basile | Podiatry | Great Lakes Foot and Ankle Centers Inc | 6123 Green Bay Rd, Suite 100, Kenosha, WI 53142-2939 |
| Shellie Kaye Babcock | Clinical Social Worker | 6123 Green Bay Rd, Suite 240, Kenosha, WI 53142-2927 | |
| Chad E Sloden | Chiropractic | Sports and Family Chiropractic LLC | 6123 Green Bay Rd, Suite 140, Kenosha, WI 53142-2927 |
| Nicholas Joseph Hollendonner | Chiropractic | Sports and Family Chiropractic LLC | 6123 Green Bay Rd, Suite 140, Kenosha, WI 53142-2927 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Randall J Hammett | Chiropractic | 6500 67th St, Kenosha, WI 53142-1403 | |
| Laurie Sasso | Clinical Social Worker | Wellqor Psychological Services of Wisconsin, S.c. | 6300 67th St, Kenosha, WI 53142-1437 |
| Pushparanee Babusukumar | Psychiatry | Psychiatric and Psychotherapy Clinic L I Newman Md Sc Gen Ptr | 6125 Green Bay Rd, Suite 700, Kenosha, WI 53142-2928 |
| Tom A Defrancesco | Clinical Social Worker | Psychiatric and Psychotherapy Clinic L I Newman Md Sc Gen Ptr | 6125 Green Bay Rd, Suite 700, Kenosha, WI 53142-2928 |
| Donna J Hayes | Podiatry | 6125 Green Bay Rd, Suite 600, Kenosha, WI 53142-2928 | |
| Corrie R Lee | Clinical Social Worker | Psychiatric and Psychotherapy Clinic L I Newman Md Sc Gen Ptr | 6125 Green Bay Rd, Suite 700, Kenosha, WI 53142-2928 |
| Lisa M Defazio | Clinical Social Worker | Psychiatric and Psychotherapy Clinic L I Newman Md Sc Gen Ptr | 6125 Green Bay Rd, Suite 700, Kenosha, WI 53142-2928 |
| Mary Girsh-jensen | Clinical Social Worker | Psychiatric and Psychotherapy Clinic L I Newman Md Sc Gen Ptr | 6125 Green Bay Rd, Suite 700, Kenosha, WI 53142-2928 |
| Sharee Lanee Chance-lawson | Family Medicine | Independent Physicians of Wisconsin LLC | 6125 Green Bay Rd, Suite 600, Kenosha, WI 53142-2928 |
| Ashokkumar K Shah | Psychiatry | Psychiatric and Psychotherapy Clinic L I Newman Md Sc Gen Ptr | 6125 Green Bay Rd, Suite 700, Kenosha, WI 53142-2928 |
| Find all physicians in zip 53142 | |||
| City | KENOSHA |
| Zip Code | 53142 |
| Specialty | PODIATRY |
| City + Specialty | KENOSHA + PODIATRY |
Please comment or provide details below to improve the information on John L Bostanche.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.