Provider Demographics
NPI:1144337460
Name:PARK, JOHN R (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:30805 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-9479
Mailing Address - Country:US
Mailing Address - Phone:262-767-0706
Mailing Address - Fax:262-767-0706
Practice Address - Street 1:248 MCHENRY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105
Practice Address - Country:US
Practice Address - Phone:262-767-8260
Practice Address - Fax:262-767-8212
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2015-08-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI23675207Y00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology