1699737288 NPI number — MR. JACOB R. DINAUER MED, ATC, EMT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699737288 NPI number — MR. JACOB R. DINAUER MED, ATC, EMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DINAUER
Provider First Name:
JACOB
Provider Middle Name:
R.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MED, ATC, EMT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699737288
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3526 W 7 MILE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALEDONIA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53108-9749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-939-6560
Provider Business Mailing Address Fax Number:
262-551-5995

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 ALFORD PARK DR
Provider Second Line Business Practice Location Address:
TARC 1150
Provider Business Practice Location Address City Name:
KENOSHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53140-1929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-551-6107
Provider Business Practice Location Address Fax Number:
262-551-5995
Provider Enumeration Date:
04/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 146M00000X , with the licence number:  304299 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2255A2300X , with the licence number: 103-039 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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