Provider Demographics
NPI:1518904762
Name:REGAN, PATRICK T (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:T
Last Name:REGAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4425 N PORT WASHINGTON RD
Mailing Address - Street 2:CSMCP CLINIC CREDENTIALING
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1082
Mailing Address - Country:US
Mailing Address - Phone:414-326-2218
Mailing Address - Fax:414-326-2208
Practice Address - Street 1:1414 N TAYLOR DRIVE
Practice Address - Street 2:COLUMBIA ST MARY'S SHEYBOYGAN OUTPATIENT CENTER
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3090
Practice Address - Country:US
Practice Address - Phone:262-243-2500
Practice Address - Fax:262-243-5395
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2014-05-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI20082207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1518904762Medicaid
WI000346210Medicare PIN
WI00673645Medicare PIN