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Jacqueline Kazik

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

Plank Road Clinic, 1155 North Mayfair Road, Milwaukee, WI 53226

PECOS Enrollment

Based on the most recent information from CMS, provider Jacqueline Kazik does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1932153277
Provider Type
Individual
Full Name
Kazik, Jacqueline
Title
Ms.
Credential
PAC

Gender
Female
Sole Proprietor
No
Enumeration Date
5/20/2006
Last Updated
9/24/2008

Contact Information

Practice Location

Plank Road Clinic, 1155 North Mayfair Road, Milwaukee, WI 53226

(414) 456-5990

Unlisted Fax

Mailing Location

1155 N Mayfair Rd, Plank Road Clinic, Milwaukee, WI 53226-3421

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 434-023 Wisconsin

Provider Identifiers

ID	Description	Issuer
ID 42916700	Description Medicaid	Issuer Unlisted Wisconsin
ID 003000261N	Description Other	Issuer HUMANA

Jacqueline Kazik

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Lemke, Pooja Singh

Burns, Gabrielle

Kapla, Trent

Montalbano, Jasper Gabriel

Loftis, Patrick

Walsh, Austin Thomas

Jodat, Jacob

Bouton, Todd Andrew

Andrews, Abigayle R

Gioia, Paige F.