Provider Demographics
NPI:1568038891
Name:PASQUA PHASE II, LLC
Entity Type:Organization
Organization Name:PASQUA PHASE II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PASQUA
Authorized Official - Suffix:
Authorized Official - Credentials:BSME, MS
Authorized Official - Phone:262-395-2250
Mailing Address - Street 1:20720 WATERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1823
Mailing Address - Country:US
Mailing Address - Phone:262-395-2250
Mailing Address - Fax:
Practice Address - Street 1:20720 WATERTOWN RD STE 220
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1823
Practice Address - Country:US
Practice Address - Phone:262-395-2250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center