Individual provider Active NPI

Mackenzie Taylor Dudek

  • Physician Assistant
  • Milwaukee, WI
National Provider Identifier
1154029817
Registry record updated May 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
507 N 17TH St
Milwaukee, WI 53233
Phone
(616) 502-8648
NPI assigned
Feb 21, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 23, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X WI Primary

Addresses

Primary practice location

507 N 17TH St
Milwaukee, WI 53233

Mailing address

507 N 17TH St
Milwaukee, WI 53233

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231003003168 WI Practitioner - Physician Assistant 3173977501 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Medicine Specialists SCGroup PAC ID 8729975461, 220 clinicians

Practice addresses (Care Compare)

201 N Mayfair Rd
Wauwatosa, WI 53226-4216
Phone (414) 259-7200

2301 N Lake Dr
Milwaukee, WI 53211-4508
Phone (414) 291-1000

375 W River Woods Pkwy
Glendale, WI 53212-1080
Phone (414) 326-1500

3801 Spring St
Mount Pleasant, WI 53405-1667
Phone (262) 687-4011

3807 Spring St
Mount Pleasant, WI 53405-1667
Phone (262) 687-8173

5000 W Chambers St
Milwaukee, WI 53210-1650
Phone (414) 447-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 1

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

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1676937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684800000000",
    "number": "1154029817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 N 17TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 N 17TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53233",
            "telephone_number": "616-502-8648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDEK",
        "first_name": "MACKENZIE",
        "middle_name": "TAYLOR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-21",
        "last_updated": "2023-05-23",
        "certification_date": "2023-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.