Provider Demographics
NPI:1982677969
Name:WOOLEVER, JON L (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:L
Last Name:WOOLEVER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:N17W24100 RIVERWOOD DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1177
Mailing Address - Country:US
Mailing Address - Phone:262-928-4100
Mailing Address - Fax:262-928-5835
Practice Address - Street 1:240 MAPLE AVE
Practice Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES INC
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-8475
Practice Address - Country:US
Practice Address - Phone:262-928-1900
Practice Address - Fax:262-363-1949
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2011-12-30
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Provider Licenses
StateLicense IDTaxonomies
WI43670207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34151700Medicaid
WI683750685Medicare PIN
WI34151700Medicaid