Nicholas Bacon, RN
Individual provider Active NPI Emergency Medicine Physician · Mequon, WI
NPI 1124933007 · NPPES record last updated Aug 17, 2026
Key facts
- NPI
- 1124933007
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 26589530 (WI)
- Practice address
- 6250 Spur Rd Apt 215
Mequon, WI 53092-4430 - Phone
- (262) 909-0561
- NPI assigned
- Aug 17, 2026
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 26589530 | WI | Yes |
Addresses
Primary practice location
6250 Spur Rd Apt 215
Mequon, WI 53092-4430
Mailing address
6250 Spur Rd Apt 215
Mequon, WI 53092-4430
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All providers in Mequon, WI · Emergency Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.