Provider Demographics
NPI:1841339181
Name:LAKOWSKE, JOHN ROBERT
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:LAKOWSKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1764
Mailing Address - Country:US
Mailing Address - Phone:308-329-6300
Mailing Address - Fax:608-328-4489
Practice Address - Street 1:1007 16TH AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1764
Practice Address - Country:US
Practice Address - Phone:308-329-6300
Practice Address - Fax:608-328-4489
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2001-028227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41699300Medicaid
WI41699300Medicaid