Provider Demographics
NPI:1295837193
Name:VIEAU, JOHN P (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:VIEAU
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:100 15TH AVE
Mailing Address - Street 2:#180
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-1160
Mailing Address - Country:US
Mailing Address - Phone:414-762-7270
Mailing Address - Fax:414-762-4225
Practice Address - Street 1:3611 S CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-3738
Practice Address - Country:US
Practice Address - Phone:414-762-7270
Practice Address - Fax:414-762-7864
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2021-12-06
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Provider Licenses
StateLicense IDTaxonomies
WI240-023363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42895700Medicaid
WI68015-0097Medicare PIN