Organization
SURGICAL ASSOCIATES OF KENOSHA S. C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER THOMAS PACANOWSKI M.D. (PRESIDENT)
(262) 656-8217
Entity
Organization
Contact information
Practice address
7600 2ND AVE, KENOSHA, WI 53143-6067
(262) 656-8217
Mailing address
7600 2ND AVE, KENOSHA, WI 53143-6067
(262) 656-8217
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
16095
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32860500
—
WI
Enumeration date
04/06/2012
Last updated
04/06/2012
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