Provider Demographics
NPI:1528001294
Name:PUJALS, JOHN SEBASTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SEBASTIAN
Last Name:PUJALS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:MICHAEL SEBASTIAN
Other - Last Name:PUJALS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:188 ROCKWOOD LN
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-1983
Practice Address - Country:US
Practice Address - Phone:920-725-4100
Practice Address - Fax:920-686-9674
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42268-020207ND0900X
WI42268-20207ZD0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00639596OtherRAILROAD MEDICARE
WI000938200OtherMEDICARE
WIBP6639504OtherDEA
WI33330200Medicaid
WI42268-020OtherSTATE LICENSE
WIH16274Medicare UPIN