Active NPI
Roger Thomas Pacanowski, M.D.
- Surgery Physician
- Kenosha, WI
National Provider Identifier
1720112030
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 16095
- Practice address
- 6308 8TH Ave
Kenosha, WI 53143-5031 - Phone
- (262) 656-8217
- NPI assigned
- Mar 16, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 16095 | WI | Primary |
Addresses
Primary practice location
6308 8TH Ave
Kenosha, WI 53143-5031
Mailing address
7600 2ND Ave
Kenosha, WI 53143-6067
Phone (262) 652-5370
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 16095 | Other | WI | MEDICAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Surgical Associates of Kenosha S. C. | Surgery | Past | Accepting new patients |
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.
-
- Surgery Physician
- Kenosha, WI
- NPI 1780940478
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720112030",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7600 2ND AVE",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531436067",
"telephone_number": "262-652-5370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6308 8TH AVE",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531435031",
"telephone_number": "262-656-8217"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACANOWSKI",
"first_name": "ROGER",
"middle_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WI",
"license": "16095",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "16095",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kenosha, WI
Sources for this page
- 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.