Provider Demographics
NPI:1164490066
Name:PAPESCH, JAMES M (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:PAPESCH
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 1:801 S MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1080
Mailing Address - Country:US
Mailing Address - Phone:847-990-5398
Mailing Address - Fax:630-645-6440
Practice Address - Street 1:801 S MILWAUKEE AVE
Practice Address - Street 2:CONDELL MEDICAL CENTER RADIOLOGY DEPARTMENT
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3204
Practice Address - Country:US
Practice Address - Phone:847-362-2900
Practice Address - Fax:847-990-5380
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI478672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34636100Medicaid
058G15875Medicare ID - Type Unspecified
WI34636100Medicaid