Provider Demographics
NPI:1063447423
Name:CARRIGAN, PATRICK M (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:M
Last Name:CARRIGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3006
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303
Mailing Address - Country:US
Mailing Address - Phone:920-499-1428
Mailing Address - Fax:920-499-5808
Practice Address - Street 1:1789 SHAWANO AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303
Practice Address - Country:US
Practice Address - Phone:920-499-1428
Practice Address - Fax:920-499-5808
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20858-0202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
14115OtherDEAN HEALTH
1018425003OtherUNITED HEALTHCARE AMERICH
WI30153800Medicaid
P00028700OtherRR MEDICARE
1018425002OtherUNITED HEALTHCARE AMERICH
MI1997693Medicaid
300020916OtherRR MEDICARE
567565OtherDEAN HEALTH
14115OtherDEAN HEALTH
1018425002OtherUNITED HEALTHCARE AMERICH
B51969Medicare UPIN
300020916OtherRR MEDICARE