Jason S So, DO
Family Medicine in Lake Geneva, WI. Individual provider (NPI-1).
NPI number1508078643
StatusActive
Last updated in NPPESAug 29, 2019
Details
- NPI
- 1508078643
- Entity type
- Individual (NPI-1)
- Name
- Jason S So
- Credential
- DO
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 3, 2007
- Last updated
- Aug 29, 2019
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - FAMILY PRACTICE
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 63015-21 | WI | Yes |
| 207Q00000X | Family Medicine | 036119919 | IL |
Practice location
350 Peller RdLake Geneva, WI 53147-4543
Phone 262-245-0221 · Fax 262-249-0633
Mailing address
350 Peller RdLake Geneva, WI 53147-4543
Phone 262-245-0221 · Fax 262-249-0633
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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