Provider Demographics
NPI:1558356956
Name:PLEVIAK, DENIS J (MD)
Entity Type:Individual
Prefix:DR
First Name:DENIS
Middle Name:J
Last Name:PLEVIAK
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 1:2020 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:NEW HOLSTEIN
Mailing Address - State:WI
Mailing Address - Zip Code:53061-1055
Mailing Address - Country:US
Mailing Address - Phone:920-898-4262
Mailing Address - Fax:
Practice Address - Street 1:2020 MADISON ST
Practice Address - Street 2:
Practice Address - City:NEW HOLSTEIN
Practice Address - State:WI
Practice Address - Zip Code:53061-1055
Practice Address - Country:US
Practice Address - Phone:920-898-4262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22908020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
391420145OtherBC
WI30335200Medicaid
B55757Medicare UPIN
10013Medicare ID - Type Unspecified
391420145OtherBC