| Froedtert South Medical Group | |
|
6308 8th Ave Kenosha WI 53143 | |
| (262) 656-2718 | |
| Not Available |
| Full Name | Froedtert South Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 6308 8th Ave, Kenosha, Wisconsin |
| Authorized Official Name and Position | Thomas J Kelley (VICE PRESIDENT & CFO) |
| Authorized Official Contact | 2625778113 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Froedtert South Medical Group Po Box 130 Kenosha WI 53141-0130 Ph: (262) 656-2930 | Froedtert South Medical Group 6308 8th Ave Kenosha WI 53143 Ph: (262) 656-2718 |
| NPI Number | 1558305284 |
|---|---|
| Provider Enumeration Date | 06/15/2006 |
| Last Update Date | 03/15/2023 |
| Medicare PECOS PAC ID | 9537071196 |
|---|---|
| Medicare Enrollment ID | O20031103000493 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558305284 | NPI | - | NPPES |
| 32815500 | Medicaid | WI | |
| CR0320 | Other | WI | MEDICARE RR |
| 213742 | Other | IL | MEDICARE |
| Provider Name | Karen A Stanlaw |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1326074360 PECOS PAC ID: 8820990302 Enrollment ID: I20040124000010 |
| Provider Name | Charles A Longdon |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1770512170 PECOS PAC ID: 1951390608 Enrollment ID: I20040508000339 |
| Provider Name | Gary J Zaid |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1316979032 PECOS PAC ID: 4385549955 Enrollment ID: I20040813001224 |
| Provider Name | Mehjabein Y Khan |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1477500312 PECOS PAC ID: 0648244772 Enrollment ID: I20040824000532 |
| Provider Name | Shahid A Atcha |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1144276551 PECOS PAC ID: 0648244483 Enrollment ID: I20040825001534 |
| Provider Name | Brian M Huettl |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1447293352 PECOS PAC ID: 2365404704 Enrollment ID: I20041028000813 |
| Provider Name | John Anthony Martini |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033119276 PECOS PAC ID: 0143284703 Enrollment ID: I20041115000523 |
| Provider Name | Goya V Raikar |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1376516229 PECOS PAC ID: 4587620133 Enrollment ID: I20041206000234 |
| Provider Name | Kevin A Khater |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1710938550 PECOS PAC ID: 9931136736 Enrollment ID: I20050723000109 |
| Provider Name | George T Poullette |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104933415 PECOS PAC ID: 7810928587 Enrollment ID: I20050823000803 |
| Provider Name | Aimee C Ledesma |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033166970 PECOS PAC ID: 0446278287 Enrollment ID: I20051109001096 |
| Provider Name | Julie A Buranosky |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1104022086 PECOS PAC ID: 2365459740 Enrollment ID: I20060309000191 |
| Provider Name | Jennifer K Takata |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992724249 PECOS PAC ID: 3375446487 Enrollment ID: I20061228000380 |
| Provider Name | William D Falco |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1588616981 PECOS PAC ID: 7416049366 Enrollment ID: I20070822001514 |
| Provider Name | Sarah J Tuohy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699960088 PECOS PAC ID: 8628164258 Enrollment ID: I20071012000331 |
| Provider Name | Anna Capelli Knight Silenzi |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1639365661 PECOS PAC ID: 2961592746 Enrollment ID: I20071217000577 |
| Provider Name | Annette Hull |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528197456 PECOS PAC ID: 2668435975 Enrollment ID: I20080111000623 |
| Provider Name | Indrajit Choudhuri |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1467621110 PECOS PAC ID: 9931270899 Enrollment ID: I20080619000712 |
| Provider Name | Tomasz M Jarzembowski |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1063636454 PECOS PAC ID: 1850490525 Enrollment ID: I20080827000550 |
| Provider Name | Phillip Y Chung |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1639165947 PECOS PAC ID: 1456362151 Enrollment ID: I20081015000386 |
| Provider Name | Leena M Joshi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003076597 PECOS PAC ID: 6608832985 Enrollment ID: I20090219000451 |
| Provider Name | Diana M Saitis |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1417177783 PECOS PAC ID: 5395898837 Enrollment ID: I20090731000454 |
| Provider Name | Kevin J Fullin |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1346224532 PECOS PAC ID: 0042366213 Enrollment ID: I20090914000569 |
| Provider Name | Lisa A Dailey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366611634 PECOS PAC ID: 3577604099 Enrollment ID: I20100106000460 |
| Provider Name | Michael Zeihen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043266992 PECOS PAC ID: 3476688177 Enrollment ID: I20100319000667 |
| Provider Name | Joel Carroll |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962411090 PECOS PAC ID: 5294865853 Enrollment ID: I20100609000413 |
| Provider Name | Shelley L Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750603130 PECOS PAC ID: 7012049844 Enrollment ID: I20100714000767 |
| Provider Name | Niraj Sawhney |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1255435285 PECOS PAC ID: 3971576620 Enrollment ID: I20100913000807 |
| Provider Name | Stacy L Hazelton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740421916 PECOS PAC ID: 4587713060 Enrollment ID: I20101005001075 |
| Provider Name | William Jeranek |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013941194 PECOS PAC ID: 9931392875 Enrollment ID: I20101022001216 |
| Provider Name | Alfred M Habel |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1760439608 PECOS PAC ID: 9830382779 Enrollment ID: I20101022001227 |
| Provider Name | Michelle Gauthier |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265489264 PECOS PAC ID: 7719170661 Enrollment ID: I20101022001266 |
| Provider Name | Janet Chua |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922032002 PECOS PAC ID: 3173716024 Enrollment ID: I20101022001276 |
| Provider Name | Wendel Friedl |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700832797 PECOS PAC ID: 9436342383 Enrollment ID: I20101022001283 |
| Provider Name | Joshua A Bloom |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1770530750 PECOS PAC ID: 5890988745 Enrollment ID: I20101022001289 |
| Provider Name | Neil Shepler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396779989 PECOS PAC ID: 2466645320 Enrollment ID: I20101022001370 |
| Provider Name | Rade Milosevic |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1891729950 PECOS PAC ID: 5991998627 Enrollment ID: I20101026000523 |
| Provider Name | Jerome P Quets |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1720007982 PECOS PAC ID: 7113111816 Enrollment ID: I20101026001576 |
| Provider Name | Andrew W Harron |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1063434322 PECOS PAC ID: 3971798141 Enrollment ID: I20101112001036 |
| Provider Name | Mario Garretto |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1497701809 PECOS PAC ID: 7810185238 Enrollment ID: I20101229000072 |
| Provider Name | Carolyn L Terry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609178607 PECOS PAC ID: 6406045764 Enrollment ID: I20110118001029 |
| Provider Name | Sharon A Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073778502 PECOS PAC ID: 7911188180 Enrollment ID: I20110221000913 |
| Provider Name | Jessica L Tommerup |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114225067 PECOS PAC ID: 7113105925 Enrollment ID: I20110627000451 |
| Provider Name | David Knight |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1598969644 PECOS PAC ID: 0941374607 Enrollment ID: I20110719000007 |
| Provider Name | Robina Naz Chowdhery |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1881803658 PECOS PAC ID: 3870762420 Enrollment ID: I20110816000536 |
| Provider Name | R Christian Rhoads |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043494792 PECOS PAC ID: 2668559964 Enrollment ID: I20111026000175 |
| Provider Name | Michael Rosenberg |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1356385330 PECOS PAC ID: 5597741280 Enrollment ID: I20120515000175 |
| Provider Name | Kelli Louise Sasada |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1265698690 PECOS PAC ID: 9032389804 Enrollment ID: I20121114000198 |
| Provider Name | Alvaro Rodrigo Encinas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891900932 PECOS PAC ID: 3375711856 Enrollment ID: I20130116000476 |
| Provider Name | Omar M Cheema |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1255358743 PECOS PAC ID: 2567468655 Enrollment ID: I20130416000684 |
| Provider Name | Matthew E Stauffer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1497066732 PECOS PAC ID: 0941443980 Enrollment ID: I20130823000624 |
| Provider Name | Mary Lillian Campagna-gibson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1629258132 PECOS PAC ID: 1052464906 Enrollment ID: I20130918000544 |
| Provider Name | Kimberly Lynn Moldenhauer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720420391 PECOS PAC ID: 5496989683 Enrollment ID: I20131001000161 |
| Provider Name | Antonio Montemurro |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1700126562 PECOS PAC ID: 5193944437 Enrollment ID: I20140918000338 |
| Provider Name | Alan Gegenheimer |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1730119561 PECOS PAC ID: 7012087158 Enrollment ID: I20150727001292 |
| Provider Name | Christopher B Wills |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558622506 PECOS PAC ID: 8224344841 Enrollment ID: I20150827001931 |
| Provider Name | Ryan J Holmbeck |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1629324538 PECOS PAC ID: 8628387701 Enrollment ID: I20151013001339 |
| Provider Name | Martin M Rene |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1144264086 PECOS PAC ID: 2365477593 Enrollment ID: I20160111001564 |
| Provider Name | Abdul Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295944163 PECOS PAC ID: 0840391272 Enrollment ID: I20160425001920 |
| Provider Name | Nancy L Aiello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821427568 PECOS PAC ID: 2961638606 Enrollment ID: I20161114000837 |
| Provider Name | Mhd Anas Alsawaf |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1144411653 PECOS PAC ID: 1254571268 Enrollment ID: I20161128000020 |
| Provider Name | Heidi Elizabeth Miess-gladding |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336683127 PECOS PAC ID: 4284916396 Enrollment ID: I20170125002991 |
| Provider Name | Hanna Mariani |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1013206556 PECOS PAC ID: 8224332325 Enrollment ID: I20170130002139 |
| Provider Name | Joyce Turley |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1871609677 PECOS PAC ID: 2466433180 Enrollment ID: I20170217001318 |
| Provider Name | Kenneth Jason Heidle |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1083059604 PECOS PAC ID: 6901196880 Enrollment ID: I20170830000713 |
| Provider Name | Heidi Capodarco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669992004 PECOS PAC ID: 7315213501 Enrollment ID: I20171016000845 |
| Provider Name | Neelam Patel Nair |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124578810 PECOS PAC ID: 7810275641 Enrollment ID: I20171016002356 |
| Provider Name | Sarah Ramadani |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396188348 PECOS PAC ID: 6002102118 Enrollment ID: I20180413001658 |
| Provider Name | Michael Babbitt |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1447697396 PECOS PAC ID: 9830408012 Enrollment ID: I20180618002398 |
| Provider Name | Nicole L Lopez |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1962897132 PECOS PAC ID: 2264787084 Enrollment ID: I20180620000441 |
| Provider Name | Andrea Alexis Gordon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306377023 PECOS PAC ID: 9032482799 Enrollment ID: I20180724001744 |
| Provider Name | Sarah M Slivon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568954337 PECOS PAC ID: 3274881024 Enrollment ID: I20180809006179 |
| Provider Name | Andrew A Mazulis |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1699031583 PECOS PAC ID: 0042515595 Enrollment ID: I20180904002651 |
| Provider Name | Kaitlin Meier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194216168 PECOS PAC ID: 2062762412 Enrollment ID: I20180905001452 |
| Provider Name | Shannon L Yow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093292625 PECOS PAC ID: 1759633712 Enrollment ID: I20181003000657 |
| Provider Name | Stephanie M Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891260543 PECOS PAC ID: 0648514943 Enrollment ID: I20181127001982 |
| Provider Name | Kelly L Riffel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467915983 PECOS PAC ID: 5698017671 Enrollment ID: I20190423000128 |
| Provider Name | Laronda James |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093274425 PECOS PAC ID: 8628310505 Enrollment ID: I20190424001419 |
| Provider Name | Eric Steinberg |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1316933054 PECOS PAC ID: 9436145752 Enrollment ID: I20190611002879 |
| Provider Name | Roni Sharon |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1548581275 PECOS PAC ID: 4385863877 Enrollment ID: I20190617001176 |
| Provider Name | Niriksha Chandrani |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1477562478 PECOS PAC ID: 6305831397 Enrollment ID: I20190709002535 |
| Provider Name | Brian Christopher Hill |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1922328921 PECOS PAC ID: 8729970850 Enrollment ID: I20190716000795 |
| Provider Name | Grethe June Mortenson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205183415 PECOS PAC ID: 7315196920 Enrollment ID: I20190920000072 |
| Provider Name | Juli Marie Degrave |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790297331 PECOS PAC ID: 2961746243 Enrollment ID: I20190920000479 |
| Provider Name | Simona Slavinskiene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669094165 PECOS PAC ID: 4789015207 Enrollment ID: I20200515001360 |
| Provider Name | Brian Tillis |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1396107405 PECOS PAC ID: 2365781473 Enrollment ID: I20200722003812 |
| Provider Name | Elias Solomon |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1770624694 PECOS PAC ID: 9931295391 Enrollment ID: I20200723000294 |
| Provider Name | Mitchell Nathan Kentor |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1114455680 PECOS PAC ID: 4880010123 Enrollment ID: I20200817002653 |
| Provider Name | Caroline Bednarski |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1407218894 PECOS PAC ID: 4981987542 Enrollment ID: I20200819001276 |
| Provider Name | Tricia Griffiths |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1174938740 PECOS PAC ID: 2769609031 Enrollment ID: I20200821001996 |
| Provider Name | Michael Rosenberg |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1811315682 PECOS PAC ID: 5193035822 Enrollment ID: I20200929000810 |
| Provider Name | Prakashkumar Nagindas Patel |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1629079801 PECOS PAC ID: 7719881267 Enrollment ID: I20201125000122 |
| Provider Name | Leslie D Reynolds |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1265511554 PECOS PAC ID: 1759373715 Enrollment ID: I20210218000155 |
| 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 | Joanne Rousseau |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1891936969 PECOS PAC ID: 2961677026 Enrollment ID: I20210503001673 |
| Provider Name | Shou Mei |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1942543897 PECOS PAC ID: 9032429139 Enrollment ID: I20210528001843 |
| Provider Name | Robert James Cronk |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1013301241 PECOS PAC ID: 0840562435 Enrollment ID: I20210729003803 |
| Provider Name | Andrew Joseph Schambers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902574098 PECOS PAC ID: 0547659310 Enrollment ID: I20211116003004 |
| Provider Name | Courtney Joy Marescalco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851051528 PECOS PAC ID: 8224420963 Enrollment ID: I20220110001245 |
| 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 | Diana Sands |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255506176 PECOS PAC ID: 6901043884 Enrollment ID: I20220224001771 |
| Provider Name | Menar Wahood |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1033578190 PECOS PAC ID: 7416241732 Enrollment ID: I20220409000161 |
| Provider Name | Raquel Mejos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114516754 PECOS PAC ID: 3375952435 Enrollment ID: I20220627001244 |
| Provider Name | Anthony Zacharias |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1063875458 PECOS PAC ID: 1254603756 Enrollment ID: I20220712003866 |
| Provider Name | Thomas Wagner |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1861841488 PECOS PAC ID: 8022309699 Enrollment ID: I20220721000643 |
| Provider Name | Elisabeth Harmeyer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750036117 PECOS PAC ID: 1759767510 Enrollment ID: I20220930001932 |
| 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 | Vijayta Geeta Bansal Kapuria |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1093900771 PECOS PAC ID: 4486876638 Enrollment ID: I20221214000139 |
| Provider Name | Prasanna Kumar Reddy Tadi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1689962441 PECOS PAC ID: 3678791241 Enrollment ID: I20230222001931 |
| Provider Name | Amin Rmeileh |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1952726358 PECOS PAC ID: 4284926015 Enrollment ID: I20230321002188 |
| Provider Name | Jonathan Ben-zev |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1245681949 PECOS PAC ID: 5890178891 Enrollment ID: I20230327001394 |
| Provider Name | Jennifer Erich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407555063 PECOS PAC ID: 0042685844 Enrollment ID: I20230410001288 |
| Provider Name | Neda Naderi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992360804 PECOS PAC ID: 0547592404 Enrollment ID: I20230425000210 |
| Provider Name | Azimabbas Saiyed |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1619405057 PECOS PAC ID: 5597037036 Enrollment ID: I20230809001214 |
| Provider Name | Omar Uddin |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1366833204 PECOS PAC ID: 2769733393 Enrollment ID: I20230809003159 |
| Provider Name | Zulfiqar Turk |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1972794014 PECOS PAC ID: 8628233194 Enrollment ID: I20230906001309 |
| Provider Name | Syed Kaunain Mehdi |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1295266245 PECOS PAC ID: 3779835756 Enrollment ID: I20230907003147 |
| Provider Name | Randa Sharag Eldin |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1780161950 PECOS PAC ID: 0345634663 Enrollment ID: I20230908002160 |
| Provider Name | Kunal Patel |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1548600240 PECOS PAC ID: 8426342502 Enrollment ID: I20230913001780 |
| Provider Name | Srikanth Davuluri |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1205034998 PECOS PAC ID: 0244493658 Enrollment ID: I20230920002028 |
| Provider Name | Adam Rizvi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841551355 PECOS PAC ID: 1456657451 Enrollment ID: I20231116002241 |
| Provider Name | Ninad Dixit |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922094655 PECOS PAC ID: 6305740507 Enrollment ID: I20240131000847 |
| Provider Name | Lauren Snower |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639459597 PECOS PAC ID: 4688812878 Enrollment ID: I20240131002091 |
| Provider Name | Xinrong Lu |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1164683447 PECOS PAC ID: 6002063401 Enrollment ID: I20240304000045 |
| Provider Name | Mutsa Vollmer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356989032 PECOS PAC ID: 1951727155 Enrollment ID: I20240304000076 |
| Provider Name | Carizza Senas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801440045 PECOS PAC ID: 7113256660 Enrollment ID: I20240304000871 |
| Provider Name | Buckley Fechter |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750868246 PECOS PAC ID: 3971838319 Enrollment ID: I20240307002833 |
| Provider Name | Mukund Venu |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1083838817 PECOS PAC ID: 0143461996 Enrollment ID: I20240403000031 |
| Provider Name | Sirisha Gudlawar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225590268 PECOS PAC ID: 5092108142 Enrollment ID: I20240404001450 |
| Provider Name | Jeffrey Jacobs |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1174524136 PECOS PAC ID: 0143290098 Enrollment ID: I20240412002864 |
| Provider Name | Renee Noelle Andrews |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1851060719 PECOS PAC ID: 4981043957 Enrollment ID: I20240424000346 |
| Provider Name | Amy Ann Giese |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1932727641 PECOS PAC ID: 2163862103 Enrollment ID: I20240424003285 |
| Provider Name | Lucas Sage |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1154826576 PECOS PAC ID: 8224368915 Enrollment ID: I20240503002061 |
| Provider Name | Jordanna Metzger |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1073376398 PECOS PAC ID: 8426499435 Enrollment ID: I20240508001980 |
| Provider Name | Brenna Sunderland-saied |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1770156663 PECOS PAC ID: 0446692172 Enrollment ID: I20240528001491 |
| Provider Name | Benjamin Scott Hungerford |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1033971395 PECOS PAC ID: 9931541372 Enrollment ID: I20240530001800 |
Steven Schwimmer, Do Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5455 Sheridan Rd, 201, Kenosha, WI 53140 Phone: 262-654-2500 Fax: 252-654-2701 | |
Leilane U Sta Romana Mdsc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3734 7th Ave, Dominican Building Suite 15, Kenosha, WI 53140 Phone: 262-658-3706 | |
Surya Medical Group Sc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6125 Green Bay Rd, Suite 100, Kenosha, WI 53142 Phone: 262-564-8636 | |
Genesis Medical Center Of Kenosha, S.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1020 35th St, Kenosha, WI 53140 Phone: 262-652-3500 Fax: 262-925-8353 | |
Great Lakes Family Medical Center Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6123 Green Bay Rd, Suite 120, Kenosha, WI 53142 Phone: 262-764-4390 Fax: 262-764-4396 | |
Gevinah Healthcare Sc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3100 Washington Rd, Kenosha, WI 53144 Phone: 310-933-5688 | |
Regina Capelli-scheidt M.d,s.c Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3601 30th Ave, Kenosha, WI 53144 Phone: 262-658-8862 Fax: 262-658-8874 |