Active NPI
Peter Dzwonkowski, MD
- Gastroenterology Physician
- Green Bay, WI
National Provider Identifier
1790701852
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 41990
- Practice address
- 1726 Shawano Ave
Green Bay, WI 54303-3216 - Phone
- (920) 496-4700
- Fax
- (920) 429-1799
- NPI assigned
- Jul 14, 2006
- 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 |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | 41990 | WI | Primary |
Addresses
Primary practice location
1726 Shawano Ave
Green Bay, WI 54303-3216
Mailing address
PO Box 19070
Prevea Health
Green Bay, WI 54307-9070
Phone (920) 496-4700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33335300 | Medicaid | WI |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41990 | WI | MD | Gastroenterology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prevea Regional Services, Inc. | Past | Accepting new patients | |
| Prevea Clinic, Inc. | Gastroenterology | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Green Bay, WI
- NPI 1194748061
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216771200000",
"number": "1790701852",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 19070",
"address_2": "PREVEA HEALTH",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543079070",
"telephone_number": "920-496-4700",
"fax_number": "920-429-1799"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1726 SHAWANO AVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543033216",
"telephone_number": "920-496-4700",
"fax_number": "920-429-1799"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DZWONKOWSKI",
"first_name": "PETER",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-14",
"last_updated": "2008-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "WI",
"license": "41990",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "33335300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.