Peter J Kordiyak, PA C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

123 Issued in WI

Practice address

200 Patriot Drive
Little Chute, WI 54140

Phone

(920) 687-2800

NPI assigned

Sep 28, 2005

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ascension Medical Group-Fox Valley Wisconsin, Inc

  • Cardiovascular Disease Physician
  • Appleton, WI
  • NPI 1831890177
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043207707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N6545 HARRISON RD",
            "city": "HILBERT",
            "state": "WI",
            "postal_code": "54129",
            "telephone_number": "920-687-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PATRIOT DRIVE",
            "city": "LITTLE CHUTE",
            "state": "WI",
            "postal_code": "54140",
            "telephone_number": "920-687-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORDIYAK",
        "first_name": "PETER",
        "middle_name": "J",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adam Matthias Hunt, MSW, LCSW
• Harriette Xaveria Janssen, RRT
• Kristin Ann Jefcik, M.S, CCC-SLP
• Kimberly Kamps
• Satia Kavanaugh Vanderloop, PHD, CRC, LPC, CSAC
• Sarah Kroll, RN
• Khaypha Kue, PHARMD
• Braden Leick
• Mark Gerard Lenz, DDS
• Little Chute Area School District

• Physician Assistant in Little Chute, WI
• Providers in Little Chute, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.