Paul Antonissen (NPI# 1174096747, PAC ID# 4688909401) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.
| Nation Provider ID (NPI) | 1174096747 |
| PAC ID by PECOS | 4688909401 |
| Professional Enrollment ID | I20190716000696 |
| Full Name | Paul Antonissen |
| Organization Legal Name | CLEANSLATE MEDICAL GROUP OF WISCONSIN SC |
| Address |
7201 Green Bay Rd Kenosha WI 53142-3532 |
| Phone Number | 4135842173 |
| Gender | M |
| Graduation Year | 2018 |
| Primary Specialty | NURSE PRACTITIONER |
| Group Practice PAC ID | 4284905134 |
| Number of Group Practice Members | 24 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 7201 Green Bay Rd, Kenosha, WI 53142-3532 | 4135842173 | CLEANSLATE MEDICAL GROUP OF WISCONSIN SC |
| Organization Legal Name | CLEANSLATE MEDICAL GROUP OF WISCONSIN SC |
| Physicians | 24 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Marta Obniski | Nurse Practitioner | Cleanslate Medical Group of Wisconsin Sc | 579 Donofrio Dr, Suite 1, Madison, WI 53719-2838 |
| Gregory Kaftan | Preventative Medicine | Cleanslate Medical Group of Wisconsin Sc | 377 W River Woods Pkwy, Suite 201, Glendale, WI 53212-1088 |
| Lauren Anne Talatzko | Physician Assistant | Cleanslate Medical Group of Wisconsin Sc | 20611 Watertown Rd, Suite E, Waukesha, WI 53186-1871 |
| Viet Vignieri | Physician Assistant | Cleanslate Medical Group of Wisconsin Sc | 1111 S 6th St, Milwaukee, WI 53204-2301 |
| Alice S Haupt | Obstetrics/gynecology | Cleanslate Medical Group of Wisconsin Sc | 800 55th St, Kenosha, WI 53140-3733 |
| Louis-marcel A Cesar | Emergency Medicine | Cleanslate Medical Group of Wisconsin Sc | 1111 S 6th St, Milwaukee, WI 53204-2301 |
| Jodi Kruszka | Nurse Practitioner | Cleanslate Medical Group of Wisconsin Sc | 1111 S 6th St, Milwaukee, WI 53204-2301 |
| Sarah M Slaasted | Nurse Practitioner | Cleanslate Medical Group of Wisconsin Sc | 377 W River Woods Pkwy, Suite 201, Glendale, WI 53212-1088 |
| Bruce Alan Weiss | Internal Medicine | Cleanslate Medical Group of Wisconsin Sc | 377 W River Woods Pkwy, Suite 201, Glendale, WI 53212-1088 |
| Laura Zellmer | Family Medicine | Cleanslate Medical Group of Wisconsin Sc | 377 W River Woods Pkwy, Suite 201, Glendale, WI 53212-1088 |
| Street Address |
7201 GREEN BAY RD |
| City | KENOSHA |
| State | WI |
| Zip | 53142-3532 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Patricia A Triscari | Nurse Practitioner | Cleanslate Medical Group of Wisconsin Sc | 7201 Green Bay Rd, Kenosha, WI 53142-3532 |
| Julia Leo | Gastroenterology | Gi Associates LLC | 7201 Green Bay Rd, Kenosha, WI 53142-3532 |
| Elizabeth Mary Timm Smith | Nurse Practitioner | Cleanslate Medical Group of Wisconsin Sc | 7201 Green Bay Rd, Kenosha, WI 53142-3532 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Randall J Hammett | Chiropractic | 6500 67th St, Kenosha, WI 53142-1403 | |
| Laurie Sasso | Clinical Social Worker | Wellqor Psychological Services of Wisconsin, S.c. | 6300 67th St, Kenosha, WI 53142-1437 |
| Rodrigo B Mata Iii | Internal Medicine | 6123 Green Bay Rd, Suite 120, Kenosha, WI 53142-2927 | |
| Nancy Guadagno | Clinical Social Worker | 6123 Green Bay Rd, Suite 240, Kenosha, WI 53142-2927 | |
| Shellie Kaye Babcock | Clinical Social Worker | 6123 Green Bay Rd, Suite 240, Kenosha, WI 53142-2927 | |
| Chad E Sloden | Chiropractic | Sports and Family Chiropractic LLC | 6123 Green Bay Rd, Suite 140, Kenosha, WI 53142-2927 |
| Nicholas Joseph Hollendonner | Chiropractic | Sports and Family Chiropractic LLC | 6123 Green Bay Rd, Suite 140, Kenosha, WI 53142-2927 |
| Pushparanee Babusukumar | Psychiatry | Psychiatric and Psychotherapy Clinic L I Newman Md Sc Gen Ptr | 6125 Green Bay Rd, Suite 700, Kenosha, WI 53142-2928 |
| Tom A Defrancesco | Clinical Social Worker | Psychiatric and Psychotherapy Clinic L I Newman Md Sc Gen Ptr | 6125 Green Bay Rd, Suite 700, Kenosha, WI 53142-2928 |
| Donna J Hayes | Podiatry | 6125 Green Bay Rd, Suite 600, Kenosha, WI 53142-2928 | |
| Find all physicians in zip 53142 | |||
| City | KENOSHA |
| Zip Code | 53142 |
| Specialty | NURSE PRACTITIONER |
| City + Specialty | KENOSHA + NURSE PRACTITIONER |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.