Provider Demographics
NPI:1053467456
Name:SLADKY, JAMES I (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:I
Last Name:SLADKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2941 S RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5517
Mailing Address - Country:US
Mailing Address - Phone:920-336-4096
Mailing Address - Fax:920-336-8093
Practice Address - Street 1:2941 S RIDGE RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5517
Practice Address - Country:US
Practice Address - Phone:920-336-4096
Practice Address - Fax:920-336-8093
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI460932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34530800Medicaid
B56664Medicare UPIN
WI002107201Medicare PIN