Theresa Pardoe D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

29660 Issued in WI

Legal business name

THERESA PARDOE D.O.

Practice address

9305 W National Ave
West Allis, WI 53227-1541

Phone

(414) 545-1120

Fax

(414) 545-2505

NPI assigned

Jul 22, 2006

Organization subpart

No

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

Authorized official

Name

Theresa Marie Pardoe, D.O.NPI 1215981733

Title

Owner

Phone

(414) 545-1120

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Theresa Marie Pardoe, M.D.

  • Family Medicine Physician
  • West Allis, WI
  • NPI 1215981733
  NPD (past) Authorized official

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185062400000",
    "number": "1083635189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9305 W NATIONAL AVE",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532271541",
            "telephone_number": "414-545-1120",
            "fax_number": "414-545-2505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9305 W NATIONAL AVE",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532271541",
            "telephone_number": "414-545-1120",
            "fax_number": "414-545-2505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERESA PARDOE D.O.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2007-07-22",
        "status": "A",
        "authorized_official_last_name": "PARDOE",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-545-1120",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "29660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31462700",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "479701014009",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in West Allis, WI
• Providers in West Allis, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 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.