Provider Demographics
NPI:1093809832
Name:SZACHNOWSKI, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:SZACHNOWSKI
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 1:515 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1569
Mailing Address - Country:US
Mailing Address - Phone:608-324-2000
Mailing Address - Fax:
Practice Address - Street 1:515 22ND AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1569
Practice Address - Country:US
Practice Address - Phone:608-324-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-087875207RR0500X
WI33335207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
110087914OtherMEDICARE RAILROAD
90707944OtherIL PUBLIC AID
10900OtherDEAN HEALTH PLAN
390808509OtherCIGNA
390808509OtherCT GENERAL
90707944006OtherBC/BS MEDICARE SUPPLEMENT
90707944006OtherCOMPCARE
WI32059600Medicaid
10900OtherMEDICAID DEAN
32059600OtherHIRSP
690004890OtherMEDICARE RAILROAD
90707944006OtherBC/BS
390808509OtherWPS
90002361OtherWEA INS
90707944OtherTRICARE
1007257OtherPHYSICIANS PLUS
39080850944OtherUNITY
59127OtherHEALTH ALLIANCE MEDICAL