1215362462 NPI number — MR. JOHN M PROTIVA INSURANCE AGENT

Table of content: MR. JOHN M PROTIVA INSURANCE AGENT (NPI 1215362462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215362462 NPI number — MR. JOHN M PROTIVA INSURANCE AGENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PROTIVA
Provider First Name:
JOHN
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
INSURANCE AGENT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PTOTIVA
Provider Other First Name:
JOHN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
INSURANCE AGENT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1215362462
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1920 WESTMOOR TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELM GROVE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53122-1063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-827-0600
Provider Business Mailing Address Fax Number:
262-827-0999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1920 WESTMOOR TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELM GROVE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53122-1063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-827-0600
Provider Business Practice Location Address Fax Number:
262-827-0999
Provider Enumeration Date:
09/06/2013

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: 171W00000X , with the licence number:  16857 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com