| Froedtert Northeast Medical Group | |
|
2300 Western Ave Manitowoc WI 54220-3712 | |
| (920) 320-2436 | |
| Not Available |
| Full Name | Froedtert Northeast Medical Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 2300 Western Ave, Manitowoc, Wisconsin |
| Authorized Official Name and Position | Michael W Degere (SECRETARY/TREASURER) |
| Authorized Official Contact | 9203202095 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Froedtert Northeast Medical Group 400 Woodland Prime Ste 103 N74 W12501 Leatherwood Court Menomonee Falls WI 53051-4490 Ph: () - | Froedtert Northeast Medical Group 2300 Western Ave Manitowoc WI 54220-3712 Ph: (920) 320-2436 |
| NPI Number | 1437829975 |
|---|---|
| Provider Enumeration Date | 09/16/2021 |
| Last Update Date | 05/29/2024 |
| Medicare PECOS PAC ID | 2365836954 |
|---|---|
| Medicare Enrollment ID | O20220224001282 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437829975 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Colleen A Marx |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891808242 PECOS PAC ID: 0244135655 Enrollment ID: I20031126000618 |
| Provider Name | Valerie J Bonne |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1407936016 PECOS PAC ID: 1850293317 Enrollment ID: I20040123001045 |
| Provider Name | Manish H Acharya |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1437129715 PECOS PAC ID: 2163316233 Enrollment ID: I20040210000609 |
| Provider Name | Nicky Plementosh |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1467461053 PECOS PAC ID: 3173417268 Enrollment ID: I20040210000737 |
| Provider Name | Paul E Koch |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306953849 PECOS PAC ID: 7012805807 Enrollment ID: I20040304000790 |
| Provider Name | Randolph B Waskin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1497780134 PECOS PAC ID: 2961390364 Enrollment ID: I20040308000878 |
| Provider Name | Matthew K Gentile |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1366551327 PECOS PAC ID: 5890685861 Enrollment ID: I20040316000478 |
| Provider Name | Rahul Verma |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1225085582 PECOS PAC ID: 2567352461 Enrollment ID: I20040316000741 |
| Provider Name | Timothy E Tanke |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1780603332 PECOS PAC ID: 1153309430 Enrollment ID: I20040713000151 |
| Provider Name | Milan Jordan |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1649264441 PECOS PAC ID: 2769453992 Enrollment ID: I20040803000179 |
| Provider Name | Derek R Bown |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1407940471 PECOS PAC ID: 7911971767 Enrollment ID: I20040827000160 |
| Provider Name | Cameron A Goetz |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1932120607 PECOS PAC ID: 8628047859 Enrollment ID: I20040924001000 |
| Provider Name | Kiernan Minehan |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1407834112 PECOS PAC ID: 3779495270 Enrollment ID: I20040930000926 |
| Provider Name | Richard J Timmons |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1366481897 PECOS PAC ID: 9638136922 Enrollment ID: I20041221000507 |
| Provider Name | Qefli Neziri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922109230 PECOS PAC ID: 6709827819 Enrollment ID: I20050519000230 |
| Provider Name | Rebecca Reim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043211766 PECOS PAC ID: 2668416744 Enrollment ID: I20050620000605 |
| Provider Name | Pradeep Giriyappa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891803862 PECOS PAC ID: 6507802055 Enrollment ID: I20050706000597 |
| Provider Name | Rick D Davis |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1861460974 PECOS PAC ID: 0345230512 Enrollment ID: I20051118000383 |
| Provider Name | Jeanne M Meier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326062118 PECOS PAC ID: 4880616903 Enrollment ID: I20060103000512 |
| Provider Name | Mohammad R Jazayeri |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1336238161 PECOS PAC ID: 8022026400 Enrollment ID: I20060327000447 |
| Provider Name | Sandra K Zernzach Schertz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841395464 PECOS PAC ID: 1355351198 Enrollment ID: I20060425000234 |
| Provider Name | Kelly R Eells |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487603593 PECOS PAC ID: 9234140443 Enrollment ID: I20060531000074 |
| Provider Name | Nathanial I Kieler |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1144282773 PECOS PAC ID: 1052315165 Enrollment ID: I20060901000358 |
| Provider Name | Ryan Michael Dopirak |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1942210729 PECOS PAC ID: 4587683552 Enrollment ID: I20060912000555 |
| Provider Name | William D Hampton |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1699766766 PECOS PAC ID: 5890731921 Enrollment ID: I20061214000400 |
| Provider Name | Rhonda M Zimmermann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720133895 PECOS PAC ID: 6103928973 Enrollment ID: I20070226000093 |
| Provider Name | Glenda A Mcconnell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316011653 PECOS PAC ID: 6800827494 Enrollment ID: I20070313000293 |
| Provider Name | Carmen Ruiz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477608529 PECOS PAC ID: 7719081157 Enrollment ID: I20070326000011 |
| Provider Name | Julia D Bell |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1508858929 PECOS PAC ID: 5991809519 Enrollment ID: I20070409000219 |
| Provider Name | Michael P Zimmerman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1518909647 PECOS PAC ID: 2365440914 Enrollment ID: I20070516000163 |
| Provider Name | Christopher Felton |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1669423398 PECOS PAC ID: 0941308332 Enrollment ID: I20070608000073 |
| Provider Name | Annette M Kaminsky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831184142 PECOS PAC ID: 6002914298 Enrollment ID: I20070612000533 |
| Provider Name | Steven J Staehling |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336105501 PECOS PAC ID: 5092807842 Enrollment ID: I20070823000894 |
| Provider Name | Mary J Gentine |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811945942 PECOS PAC ID: 5496847246 Enrollment ID: I20070823000961 |
| Provider Name | Shahida R Munim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255331831 PECOS PAC ID: 4284729773 Enrollment ID: I20070928000031 |
| Provider Name | Christopher M Wolfram |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1740242155 PECOS PAC ID: 0840261350 Enrollment ID: I20071019000470 |
| Provider Name | James Rider |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1568525988 PECOS PAC ID: 4082651278 Enrollment ID: I20071115000459 |
| Provider Name | Javaid M Abbasi |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1831127562 PECOS PAC ID: 6507832037 Enrollment ID: I20080207000061 |
| Provider Name | Sampoornima Setty |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1851398283 PECOS PAC ID: 8527090703 Enrollment ID: I20080707000574 |
| Provider Name | Matthew Campbell |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1821030859 PECOS PAC ID: 8224082011 Enrollment ID: I20080709000330 |
| Provider Name | Vijaya K Munagala |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1780644666 PECOS PAC ID: 6406755339 Enrollment ID: I20080808000751 |
| Provider Name | Andrew E Trochlell |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1851489967 PECOS PAC ID: 5395810162 Enrollment ID: I20080814000095 |
| Provider Name | Daniel W Hampton |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1225226863 PECOS PAC ID: 4587745864 Enrollment ID: I20080819000931 |
| Provider Name | Jennifer L Paltzer |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1053306944 PECOS PAC ID: 4183790652 Enrollment ID: I20080906000133 |
| Provider Name | Suzanne V Powell |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1265458053 PECOS PAC ID: 6709777444 Enrollment ID: I20081030000730 |
| Provider Name | Dana M Waters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659526614 PECOS PAC ID: 6608933445 Enrollment ID: I20090324000243 |
| Provider Name | Joseph Y Ahn |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487789863 PECOS PAC ID: 6901958982 Enrollment ID: I20090722000567 |
| Provider Name | Ronald Andrew Rimmer |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1568414910 PECOS PAC ID: 6709938780 Enrollment ID: I20090722000587 |
| Provider Name | Donnevan Blake |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1801854898 PECOS PAC ID: 4385727486 Enrollment ID: I20090923000493 |
| Provider Name | Jeffrey S Allen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962410514 PECOS PAC ID: 8729124466 Enrollment ID: I20091009000551 |
| Provider Name | Janis P Tupesis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1851454375 PECOS PAC ID: 5597727727 Enrollment ID: I20091030000313 |
| Provider Name | Jennifer H Giebel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386877538 PECOS PAC ID: 2163560913 Enrollment ID: I20091116000230 |
| Provider Name | Michael E Hiebert |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407841224 PECOS PAC ID: 3678612066 Enrollment ID: I20091124000378 |
| Provider Name | Robert P Limoni |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1548206444 PECOS PAC ID: 8729974530 Enrollment ID: I20100112000745 |
| Provider Name | Mary L Stoffel |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1437111036 PECOS PAC ID: 1254336753 Enrollment ID: I20100209000269 |
| Provider Name | Courtney W Whitney |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1861461329 PECOS PAC ID: 9739087826 Enrollment ID: I20100521000043 |
| Provider Name | Joel H Lundberg |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1306827621 PECOS PAC ID: 8426187345 Enrollment ID: I20100602000177 |
| Provider Name | John Trotter |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1992812002 PECOS PAC ID: 5496885949 Enrollment ID: I20100610000516 |
| Provider Name | Cheryl Lynn M Pitre |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801881214 PECOS PAC ID: 6103956271 Enrollment ID: I20100616000490 |
| Provider Name | Jonathan L Klatt |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1689787756 PECOS PAC ID: 0648302273 Enrollment ID: I20100719000119 |
| Provider Name | Lynn M Baatz |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1518070077 PECOS PAC ID: 0446382071 Enrollment ID: I20100719000143 |
| Provider Name | Randolph J Lipchik |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1891746640 PECOS PAC ID: 7911030630 Enrollment ID: I20100802000863 |
| Provider Name | Robert M Horth |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1699768259 PECOS PAC ID: 9638150857 Enrollment ID: I20100818000972 |
| Provider Name | Denise A Kennedy |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1407896962 PECOS PAC ID: 3577755651 Enrollment ID: I20101007000683 |
| Provider Name | David K Mikolyzk |
|---|---|
| Provider Type | Practitioner - Hand Surgery |
| Provider Identifiers | NPI Number: 1437312774 PECOS PAC ID: 9234283680 Enrollment ID: I20101014000719 |
| Provider Name | Eric Boehmer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023217528 PECOS PAC ID: 9739372608 Enrollment ID: I20101023000126 |
| Provider Name | Herbert C Coussons |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1427007624 PECOS PAC ID: 4284699117 Enrollment ID: I20101027000327 |
| Provider Name | John L Olsen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033389085 PECOS PAC ID: 0446445191 Enrollment ID: I20101108001454 |
| Provider Name | Peter C Rotter |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1508979691 PECOS PAC ID: 8123213238 Enrollment ID: I20101115001312 |
| Provider Name | Michael D Hoftiezer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639287618 PECOS PAC ID: 1254528540 Enrollment ID: I20101213000877 |
| Provider Name | David E Augustine |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619083185 PECOS PAC ID: 0042407348 Enrollment ID: I20101213000926 |
| Provider Name | Benjamin Genesis Bautista |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1396051561 PECOS PAC ID: 5597954735 Enrollment ID: I20110104000950 |
| Provider Name | Michael W.b. Mccormick |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1366557852 PECOS PAC ID: 7012091549 Enrollment ID: I20110105001245 |
| Provider Name | Margaret Klatt |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1437262516 PECOS PAC ID: 4385833193 Enrollment ID: I20110110000758 |
| Provider Name | John G Brady |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1649210105 PECOS PAC ID: 1052303682 Enrollment ID: I20110113000038 |
| Provider Name | Bob H Greene |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1497855803 PECOS PAC ID: 9133318447 Enrollment ID: I20110118000520 |
| Provider Name | Mark L Herring |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386766368 PECOS PAC ID: 3173706520 Enrollment ID: I20110323000537 |
| Provider Name | Colleen M Gumm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750603114 PECOS PAC ID: 6406031301 Enrollment ID: I20110419000426 |
| Provider Name | Edward L Smith |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1962617845 PECOS PAC ID: 8921277336 Enrollment ID: I20110801000592 |
| Provider Name | Paul A Hudson |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1417094772 PECOS PAC ID: 6103918248 Enrollment ID: I20110826000501 |
| Provider Name | Sumit N Ringwala |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1316089154 PECOS PAC ID: 4082889613 Enrollment ID: I20111209000754 |
| Provider Name | Matthew Nelson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1720030422 PECOS PAC ID: 7214969039 Enrollment ID: I20121011000925 |
| Provider Name | Shahram Bahrami |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1578771010 PECOS PAC ID: 3375602410 Enrollment ID: I20130115000449 |
| Provider Name | Jeremy R Anclam |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1841495058 PECOS PAC ID: 5294975173 Enrollment ID: I20130717000849 |
| Provider Name | Christy D Short |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1659699833 PECOS PAC ID: 5799910055 Enrollment ID: I20131023000730 |
| Provider Name | Rebecca Mueller |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1285759423 PECOS PAC ID: 1658506175 Enrollment ID: I20131108000553 |
| Provider Name | Sonya R Hollingsworth |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770697856 PECOS PAC ID: 1456361260 Enrollment ID: I20131121001329 |
| Provider Name | Steven D Bush |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1598879777 PECOS PAC ID: 3476443763 Enrollment ID: I20131122000599 |
| Provider Name | Anthony Kehr |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629225099 PECOS PAC ID: 5395918304 Enrollment ID: I20140521000689 |
| Provider Name | Kathleen A Hughes-kuda |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518022748 PECOS PAC ID: 7113162041 Enrollment ID: I20140604001511 |
| Provider Name | Courtney Collien |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124443726 PECOS PAC ID: 3476777699 Enrollment ID: I20140610000206 |
| Provider Name | Sarah L Holets |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1124380803 PECOS PAC ID: 3779704242 Enrollment ID: I20141027000814 |
| Provider Name | Rebecca R Hoerth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215336730 PECOS PAC ID: 2567684145 Enrollment ID: I20141114001663 |
| Provider Name | Rebecca J Carpenter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417358623 PECOS PAC ID: 9335462654 Enrollment ID: I20141217002271 |
| Provider Name | Kimberly M Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871541342 PECOS PAC ID: 4981922325 Enrollment ID: I20150414001818 |
| Provider Name | Megan M Ingersoll |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1720257157 PECOS PAC ID: 0648359539 Enrollment ID: I20150527001924 |
| Provider Name | Ben Harris |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1700041167 PECOS PAC ID: 0345437950 Enrollment ID: I20150601002450 |
| Provider Name | Katie J Rettler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225301039 PECOS PAC ID: 6800056482 Enrollment ID: I20150603001767 |
| Provider Name | Matthew John Mcfarlane |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1477873743 PECOS PAC ID: 0547408924 Enrollment ID: I20150720001419 |
| Provider Name | Sarah Reveal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487037859 PECOS PAC ID: 5395050165 Enrollment ID: I20150824000718 |
| Provider Name | Veronica Mcfarlane |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063809499 PECOS PAC ID: 1153637079 Enrollment ID: I20150908002012 |
| Provider Name | Melissa Koss |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437527389 PECOS PAC ID: 2466761952 Enrollment ID: I20151023001037 |
| Provider Name | Ryan H Holzhauer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1508272139 PECOS PAC ID: 9234422353 Enrollment ID: I20160727001944 |
| Provider Name | Shad M Winget |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1457709602 PECOS PAC ID: 8123312857 Enrollment ID: I20160803001745 |
| Provider Name | Katelin Krystowiak |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407198716 PECOS PAC ID: 5991090755 Enrollment ID: I20160818002148 |
| Provider Name | Stephen Ira Eskin |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1871515379 PECOS PAC ID: 6800804162 Enrollment ID: I20170215000422 |
| Provider Name | Rory Tropp |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1801855747 PECOS PAC ID: 9537068572 Enrollment ID: I20170412002109 |
| Provider Name | Emily J Graf |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1942542584 PECOS PAC ID: 7911139969 Enrollment ID: I20170714001838 |
| Provider Name | Christopher Tl Bender |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1043637903 PECOS PAC ID: 9830319359 Enrollment ID: I20170718003459 |
| Provider Name | Christopher J Keto |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1134446339 PECOS PAC ID: 4981844743 Enrollment ID: I20170731001875 |
| Provider Name | Doreen M Krause |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659653301 PECOS PAC ID: 5597083303 Enrollment ID: I20170814001776 |
| Provider Name | Amber L Kornely |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942725825 PECOS PAC ID: 3779857230 Enrollment ID: I20170921001946 |
| Provider Name | Promila K Timothy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912127424 PECOS PAC ID: 7214095397 Enrollment ID: I20171018002741 |
| Provider Name | Howard Johnson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1639168560 PECOS PAC ID: 3678557337 Enrollment ID: I20180116001363 |
| Provider Name | Robert A Prahl |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1598074429 PECOS PAC ID: 8527285022 Enrollment ID: I20180123002062 |
| Provider Name | Joseph S Brantman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1982090676 PECOS PAC ID: 0749594018 Enrollment ID: I20180716001299 |
| Provider Name | Zachary D Morrow |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1699268276 PECOS PAC ID: 8921356817 Enrollment ID: I20180809000871 |
| Provider Name | Jenna Mae Domino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780174664 PECOS PAC ID: 8628329133 Enrollment ID: I20180922000031 |
| Provider Name | Catherine Lee Turner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154812170 PECOS PAC ID: 4486906856 Enrollment ID: I20181012000566 |
| Provider Name | Ann J Rojaz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750866646 PECOS PAC ID: 5698028892 Enrollment ID: I20181105000687 |
| Provider Name | Joseph D Chabot |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1033421623 PECOS PAC ID: 7618196221 Enrollment ID: I20190812001181 |
| Provider Name | Jesse Chiu |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1881183259 PECOS PAC ID: 9234485376 Enrollment ID: I20190830002722 |
| Provider Name | Danielle L Leick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902467731 PECOS PAC ID: 6002145950 Enrollment ID: I20190903001110 |
| Provider Name | Xia N Vang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750745162 PECOS PAC ID: 4183917685 Enrollment ID: I20190913001358 |
| Provider Name | Kelly J Rehfeldt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497308233 PECOS PAC ID: 9638409667 Enrollment ID: I20190918000598 |
| Provider Name | Carmen Alcala |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1639583560 PECOS PAC ID: 8325343460 Enrollment ID: I20191011001212 |
| Provider Name | John P Budi |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1891050217 PECOS PAC ID: 4789981390 Enrollment ID: I20200130001201 |
| Provider Name | Matthew D Doll |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548390560 PECOS PAC ID: 6608975123 Enrollment ID: I20200310002130 |
| Provider Name | Richard Manos |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1356451249 PECOS PAC ID: 4981761848 Enrollment ID: I20200319000795 |
| Provider Name | Brian P Cone |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1578859328 PECOS PAC ID: 7113153354 Enrollment ID: I20200501000839 |
| Provider Name | Gearin A Green |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1871806315 PECOS PAC ID: 9739310111 Enrollment ID: I20200811001111 |
| Provider Name | Laura S Beacher |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1245659051 PECOS PAC ID: 6800175290 Enrollment ID: I20200904000729 |
| Provider Name | Krista Lyn Fogltanz |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1174140115 PECOS PAC ID: 0648698316 Enrollment ID: I20200911001372 |
| Provider Name | Daniel D Kopatich |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1659802197 PECOS PAC ID: 4789012865 Enrollment ID: I20200916000161 |
| Provider Name | Samantha Kapphahn |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1548420904 PECOS PAC ID: 0345483384 Enrollment ID: I20200922002754 |
| Provider Name | Kimberly Idoko |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1003080896 PECOS PAC ID: 2769605344 Enrollment ID: I20200922003082 |
| Provider Name | Nicole M Aman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699386367 PECOS PAC ID: 0648699900 Enrollment ID: I20201006001646 |
| Provider Name | Aleem Bakhtiar |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1053706044 PECOS PAC ID: 1951656321 Enrollment ID: I20201006002916 |
| Provider Name | Andrew Albert |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1659413656 PECOS PAC ID: 4082710561 Enrollment ID: I20201009000195 |
| Provider Name | Zahid Afzal |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1528044518 PECOS PAC ID: 4981697422 Enrollment ID: I20201014001755 |
| Provider Name | Prakashkumar Nagindas Patel |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1629079801 PECOS PAC ID: 7719881267 Enrollment ID: I20201125000122 |
| Provider Name | Jason M Ricci |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1750596466 PECOS PAC ID: 9830367523 Enrollment ID: I20210108001900 |
| Provider Name | Clifton A Robinson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1538279567 PECOS PAC ID: 6204879281 Enrollment ID: I20210210001061 |
| Provider Name | Serena Ashour |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023623832 PECOS PAC ID: 7012322951 Enrollment ID: I20210226000895 |
| Provider Name | Fawad Mian |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1306006242 PECOS PAC ID: 0042364622 Enrollment ID: I20210308000402 |
| Provider Name | Laxmi Dhakal |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1598997348 PECOS PAC ID: 0446490056 Enrollment ID: I20210420001089 |
| Provider Name | Stacy L Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699011825 PECOS PAC ID: 0446506893 Enrollment ID: I20210429002203 |
| Provider Name | Jacob Ian Maclean |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902393994 PECOS PAC ID: 9931445129 Enrollment ID: I20210811002731 |
| Provider Name | Sunil Reddy |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1851787782 PECOS PAC ID: 8022319672 Enrollment ID: I20210818000216 |
| Provider Name | Rudolph Francis Evonich |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1205909967 PECOS PAC ID: 9537269055 Enrollment ID: I20211018000695 |
| Provider Name | Katie Ann Nebel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225576317 PECOS PAC ID: 8628468501 Enrollment ID: I20211208001902 |
| Provider Name | Kristen M Kelly-williams |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1659532265 PECOS PAC ID: 6305093873 Enrollment ID: I20220121001539 |
| Provider Name | Bo Leung |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1932635539 PECOS PAC ID: 4688087513 Enrollment ID: I20220221001176 |
| Provider Name | Girish Singhania |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1558660217 PECOS PAC ID: 8527297100 Enrollment ID: I20220314001593 |
| Provider Name | Rebecca Schmitt |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1285049460 PECOS PAC ID: 2062809312 Enrollment ID: I20220505000415 |
| Provider Name | Nebiyu A Tilahun |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1356800478 PECOS PAC ID: 5698154144 Enrollment ID: I20220614001663 |
| Provider Name | Mekbib G Onkiso |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477013993 PECOS PAC ID: 4981083300 Enrollment ID: I20220615001390 |
| Provider Name | Matthew Kyle Rafn |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1922494285 PECOS PAC ID: 8921318130 Enrollment ID: I20220816002163 |
| Provider Name | Lauren Marie Schneider |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750018198 PECOS PAC ID: 9931582012 Enrollment ID: I20220823001640 |
| Provider Name | Dhara Digant Patel |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1174907711 PECOS PAC ID: 7214229277 Enrollment ID: I20220908002366 |
| Provider Name | Lyle Dennis |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1598729220 PECOS PAC ID: 6406807395 Enrollment ID: I20221019000386 |
| Provider Name | Natasa Bratislav Dragicevic |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1124386156 PECOS PAC ID: 9830476654 Enrollment ID: I20221201000365 |
| Provider Name | Jose Maria Ochoa |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1144548876 PECOS PAC ID: 5193952299 Enrollment ID: I20221206002543 |
| Provider Name | Anthony Nuval |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1508251109 PECOS PAC ID: 9133404494 Enrollment ID: I20221208000769 |
| Provider Name | Michelle Lynne Gorey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508534363 PECOS PAC ID: 1254700941 Enrollment ID: I20221220002170 |
| Provider Name | Abbey B Gaske |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1265426886 PECOS PAC ID: 9830166404 Enrollment ID: I20221220002618 |
| Provider Name | David Slobodkin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1194795591 PECOS PAC ID: 3678545928 Enrollment ID: I20230104003063 |
| Provider Name | John J Troyer |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1023740701 PECOS PAC ID: 4183095201 Enrollment ID: I20230126003245 |
| Provider Name | Anthony Ashkar |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1376862417 PECOS PAC ID: 0143462432 Enrollment ID: I20230130001145 |
| Provider Name | Danna A Derenne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881320760 PECOS PAC ID: 3779955687 Enrollment ID: I20230210000001 |
| Provider Name | Prasanna Kumar Reddy Tadi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1689962441 PECOS PAC ID: 3678791241 Enrollment ID: I20230222001931 |
| Provider Name | Ami J Depew |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1376617647 PECOS PAC ID: 5496129355 Enrollment ID: I20230316002082 |
| Provider Name | Maureen Muecke |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1689600579 PECOS PAC ID: 4284626110 Enrollment ID: I20230317002338 |
| Provider Name | Clare E Zimmerman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679270060 PECOS PAC ID: 2163896986 Enrollment ID: I20230317002370 |
| Provider Name | Jaclyn K Sullivan |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1235338377 PECOS PAC ID: 0941674527 Enrollment ID: I20230322001027 |
| Provider Name | Brennan Weber |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1265882807 PECOS PAC ID: 9830469980 Enrollment ID: I20230407000757 |
| Provider Name | Trevor A Fisher |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1336101567 PECOS PAC ID: 6709831092 Enrollment ID: I20230407000927 |
| Provider Name | Arun Ranganath |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1720224223 PECOS PAC ID: 5092851329 Enrollment ID: I20230412001751 |
| Provider Name | Kristofer Michael Dosh |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1790999092 PECOS PAC ID: 4385814110 Enrollment ID: I20230417001546 |
| Provider Name | Ifeanyi Iwuchukwu |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1215169974 PECOS PAC ID: 6608056312 Enrollment ID: I20230428000587 |
| Provider Name | Ajit Nandkumar Chary |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1396184214 PECOS PAC ID: 0143453043 Enrollment ID: I20230530000543 |
| Provider Name | Lindsey M Novack |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629575261 PECOS PAC ID: 9032578869 Enrollment ID: I20230711002433 |
| Provider Name | Darshan R Dhingani |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1053547968 PECOS PAC ID: 3274797196 Enrollment ID: I20230731002279 |
| Provider Name | Jeremy M Silver |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396034161 PECOS PAC ID: 0941595466 Enrollment ID: I20230807001764 |
| Provider Name | Shirin Pilakka Kandakkil |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811514656 PECOS PAC ID: 4284096959 Enrollment ID: I20230811001347 |
| Provider Name | Maria Victoria Recio-restrepo |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1245214766 PECOS PAC ID: 9931122835 Enrollment ID: I20230814002413 |
| Provider Name | Salil Kalra |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275983744 PECOS PAC ID: 6002109329 Enrollment ID: I20230816002070 |
| Provider Name | Samuel Q Ballard |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578191763 PECOS PAC ID: 6709249196 Enrollment ID: I20230901001054 |
| Provider Name | Lori Schuette |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831447424 PECOS PAC ID: 4183087471 Enrollment ID: I20230905001793 |
| Provider Name | Jin Yuan Wang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396372850 PECOS PAC ID: 1254794548 Enrollment ID: I20230905001885 |
| Provider Name | Jessica L Lietzan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043901085 PECOS PAC ID: 0941663249 Enrollment ID: I20230905002126 |
| Provider Name | Zulfiqar Turk |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1972794014 PECOS PAC ID: 8628233194 Enrollment ID: I20230906001309 |
| Provider Name | Azmi Ramin Jahan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437683968 PECOS PAC ID: 5496029142 Enrollment ID: I20230921001859 |
| Provider Name | Jill Green |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1972730059 PECOS PAC ID: 8123275906 Enrollment ID: I20230928001526 |
| Provider Name | Ted Samawi |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1891010591 PECOS PAC ID: 3173768512 Enrollment ID: I20231002002831 |
| Provider Name | Tamiru Tumdedo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164085031 PECOS PAC ID: 5496100893 Enrollment ID: I20231004002374 |
| Provider Name | Qaiser Toqeer |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1093079048 PECOS PAC ID: 3173764446 Enrollment ID: I20231004003130 |
| Provider Name | Nicole A Kakuk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790220044 PECOS PAC ID: 3072969237 Enrollment ID: I20231024001595 |
| Provider Name | Jasjot Kaur Bhullar |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1366602229 PECOS PAC ID: 7719038751 Enrollment ID: I20231031003367 |
| Provider Name | Adam Rizvi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1841551355 PECOS PAC ID: 1456657451 Enrollment ID: I20231101001255 |
| Provider Name | Donald Baracskay |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760564207 PECOS PAC ID: 3072406891 Enrollment ID: I20231108002415 |
| Provider Name | Kalyan Sajja |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1346682861 PECOS PAC ID: 1052542347 Enrollment ID: I20231207001766 |
| Provider Name | Jason R Sebesto |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1861786246 PECOS PAC ID: 0749416238 Enrollment ID: I20231208002478 |
| Provider Name | Lindsey Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861178527 PECOS PAC ID: 7416306436 Enrollment ID: I20231215000079 |
| Provider Name | Yuhann Kenneth Lim Lopez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104093863 PECOS PAC ID: 5799901310 Enrollment ID: I20231221001818 |
| Provider Name | Brittney Lapalme |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1013603059 PECOS PAC ID: 1456703404 Enrollment ID: I20240116002210 |
| Provider Name | Brian Boomgarden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871510677 PECOS PAC ID: 1355784372 Enrollment ID: I20240207000779 |
| Provider Name | Peter Vu Bui |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1730507575 PECOS PAC ID: 0446479117 Enrollment ID: I20240229003857 |
| Provider Name | Pooja Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104454479 PECOS PAC ID: 1254778673 Enrollment ID: I20240321001053 |
| Provider Name | John Nicholas Moustoukas |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1124317847 PECOS PAC ID: 3779712914 Enrollment ID: I20240325001720 |
| Provider Name | Jin Kim |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1679597835 PECOS PAC ID: 1355333147 Enrollment ID: I20240405003481 |
| Provider Name | Kelsey Hoffman |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1073994083 PECOS PAC ID: 5991144131 Enrollment ID: I20240419002396 |
| Provider Name | Darron Lewis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649767658 PECOS PAC ID: 6406181452 Enrollment ID: I20240510000598 |
| Provider Name | Amanda Hartwig |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1932699063 PECOS PAC ID: 3173964988 Enrollment ID: I20240510001960 |
| Provider Name | Rachel Gordon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215302237 PECOS PAC ID: 2769823475 Enrollment ID: I20240513002152 |
Rogers Memorial Hospital Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 818 State St, Manitowoc, WI 54220 Phone: 800-767-4411 | |
Mark L Herring M.d., S.c. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1355 Johnston Dr, Manitowoc, WI 54220 Phone: 920-682-2747 Fax: 920-686-1498 | |
Hfm Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1650 S 41st St, Manitowoc, WI 54220 Phone: 920-320-4500 Fax: 920-682-9378 | |
Lakeshore Community Health Care, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 601 Buffalo St, Manitowoc, WI 54220 Phone: 920-686-2333 Fax: 920-783-6392 | |
Hoffman Geriatric Services Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2021 S Alverno Rd, Manitowoc, WI 54220 Phone: 920-686-1822 Fax: 920-686-7448 | |
Bellin Memorial Hospital Inc. Dba Fmc Manitowoc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1765 N 18th St, Manitowoc, WI 54220 Phone: 920-482-9394 Fax: 920-482-0579 | |
Fmc Manitowoc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3415 Custer St, Suite D, Manitowoc, WI 54220 Phone: 920-652-9310 |