Provider Demographics
NPI:1083670244
Name:PAWLAK, JAMES R (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:PAWLAK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:FROEDTERT & MCW SHEBOYGAN TAYLOR CLINIC
Mailing Address - Street 2:1414 N. TAYLOR DR.
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081
Mailing Address - Country:US
Mailing Address - Phone:920-476-6300
Mailing Address - Fax:920-476-6301
Practice Address - Street 1:1703 N TAYLOR DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-1933
Practice Address - Country:US
Practice Address - Phone:920-457-4438
Practice Address - Fax:920-457-6748
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI20830-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30301200Medicaid
B55641Medicare UPIN
WI000660080Medicare ID - Type Unspecified