Provider Demographics
NPI:1467657478
Name:SZPAK, JASON G (PA)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:G
Last Name:SZPAK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3077 N MAYFAIR RD STE 305
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-4305
Mailing Address - Country:US
Mailing Address - Phone:414-384-6700
Mailing Address - Fax:414-727-1058
Practice Address - Street 1:2323 N MAYFAIR RD
Practice Address - Street 2:SUITE 310
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1506
Practice Address - Country:US
Practice Address - Phone:414-384-6700
Practice Address - Fax:414-727-1058
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI2125023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41944700Medicaid
WI01295Medicare PIN