Robert Perzacki, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

42925-020 Issued in WI

Practice address

1820 Appleton Rd
Menasha, WI 54952-1110

Phone

(920) 996-2200

Fax

(920) 996-2214

NPI assigned

Jul 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• The Medical College of Wisconsin, Inc.

  • Internal Medicine Physician
  • Milwaukee, WI
  • NPI 1699720086
  NPD (past)

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1396761276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 APPLETON RD",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521110",
            "telephone_number": "920-996-2200",
            "fax_number": "920-996-2214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1820 APPLETON RD",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521110",
            "telephone_number": "920-996-2200",
            "fax_number": "920-996-2214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERZACKI",
        "first_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MN",
            "license": "47360",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "WI",
            "license": "42925-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "P1",
            "identifier": "1043361",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "405L5PE",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1396761276",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "378616100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HP",
            "identifier": "48630",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UC",
            "identifier": "104348",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBH",
            "identifier": "15-55187",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Mae Paske, SAC
• Patriot Partners Removal
• Michelle Paulson, RN
• Meghan Annette Pauly, R.N.
• Melissa J Pecor, PHD
• Eric Richard Petersen
• Lauren Claire Petersen, MA, CF-SLP
• Samantha Jo Petersen, APSW
• John H. Peterson, MS
• Thomas Nathaniel Pfister, LPC, CSAC

• Child & Adolescent Psychiatry Physician in Menasha, WI
• Providers in Menasha, WI by specialty
• Child & Adolescent Psychiatry Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.