Active NPI
John S Cantieri, MD
- Dermatology Physician
- Brookfield, WI
National Provider Identifier
1952376808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 23629020
- Practice address
- 17100 W North Ave
Suite 200
Brookfield, WI 53005 - Phone
- (262) 784-3800
- Fax
- (262) 784-7936
- NPI assigned
- Feb 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 23629020 | WI | Primary |
Addresses
Primary practice location
17100 W North Ave
Suite 200
Brookfield, WI 53005
Mailing address
801 York Street
Manitowoc, WI 54220-4630
Phone (920) 663-9146
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30381500 | Medicaid | WI | |
| 23629 | Other | WI | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23629020 | WI | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140566400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1952376808",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 YORK STREET",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542204630",
"telephone_number": "920-663-9146",
"fax_number": "920-684-1439"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17100 W NORTH AVE",
"address_2": "SUITE 200",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "53005",
"telephone_number": "262-784-3800",
"fax_number": "262-784-7936"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANTIERI",
"first_name": "JOHN",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-22",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "WI",
"license": "23629020",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30381500",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "23629",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brookfield, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.