Provider Demographics
NPI:1558330654
Name:PAYKEL, JACQUELYN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:MARIE
Last Name:PAYKEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:MARIE
Other - Last Name:MCLEES PAYKEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:21700 INTERTECH DR
Mailing Address - Street 2:SPRINGDALE HEALTH CENTER
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-5197
Mailing Address - Country:US
Mailing Address - Phone:262-532-8300
Mailing Address - Fax:262-532-8600
Practice Address - Street 1:21700 INTERTECH DR
Practice Address - Street 2:SPRINGDALE HEALTH CENTER
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-5197
Practice Address - Country:US
Practice Address - Phone:262-532-8300
Practice Address - Fax:262-532-8600
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244481207V00000X
WI41647207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1558330654Medicaid
WI1558330654Medicaid
WI736012269Medicare PIN
WI680860628Medicare PIN
WI1558330654Medicaid
VAMC11809Medicare PIN