Individual
DR. ROGER THOMAS PACANOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6308 8TH AVE, KENOSHA, WI 53143-5031
(262) 656-8217
Mailing address
7600 2ND AVE, KENOSHA, WI 53143-6067
(262) 652-5370
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
16095
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16095
MEDICAL LICENSE
WI
Enumeration date
03/16/2007
Last updated
07/08/2007
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