DR. MOHAMED S EL-JACK (NPI# 1538260005) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538260005 |
| Entity Type | Individual |
| Full Name | DR. MOHAMED S EL-JACK |
| Practice Address |
3003 University Dr Ste 301 Marinette WI 54143 |
| Mailing Address |
3003 University Dr Marinette WI 54143-4110 |
| Practice Telephone | 7157328491 |
| Mailing Telephone | 7157354200 |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2020-01-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | 44615 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 104434930 | 05 | |
| WI | 1538260005 | 05 | |
| DEA NUMBER | BE7933953 | 01 | |
| MI | 1538260005 | 05 | |
| WI | 34272500 | 05 |
| Street Address |
3003 UNIVERSITY DR STE 301 |
| City | MARINETTE |
| State | WI |
| Zip Code | 54143 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669966750 | Allie Parthie | Dentist | 1420 University Dr, Marinette, WI 54143 | 2018-06-21 |
| 1043730690 | Jonathan Weseman | Emergency Medicine | 3003 University Dr, Marinette, Marinette, WI 54143 | 2017-06-25 |
| 1538698618 | Meghan M Russell | Nurse Practitioner | 4061 Old Peshtigo Road, Marinette, WI 54143 | 2017-06-12 |
| 1801279435 | Stephanie Miller | Licensed Practical Nurse | W1902 State Hwy 64, Marinette, WI 54143 | 2015-07-01 |
| 1417298704 | Danielle Risner | Occupational Therapist | Luther Home 831 Pine Beach Rd, Marinette, WI 54143 | 2013-03-12 |
| 1053631903 | Lincare Inc. | Durable Medical Equipment & Medical Supplies | W 716 County B, Ste B, Marinette, WI 54143 | 2010-06-02 |
| 1417105545 | Forefront Dermatology, S.c. | Dermatology | 3515 Murray Street, Marinette, WI 54143 | 2008-09-03 |
| 1245493352 | Judith M Ribbens | Counselor | 1557 Cleveland Ave, Marinette, WI 54143 | 2008-07-08 |
| 1538338926 | Charlene Mae Miller | Licensed Practical Nurse | 1126 Daggett, Marinette, WI 54143 | 2008-02-29 |
| 1104025519 | James Alan Boren | Family Medicine | 5926 Highway 41, Stephenson, MI 54143 | 2007-07-16 |
| Find all providers in zip 54143 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396015194 | Bay Area Medical Center, Inc | Urology | 3130 Shore Dr, Suite 020, Marinette, WI 54143-4291 | 2012-01-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649520180 | George Leonard Apfelbach Jr. | Urology | 4098 Main St, Fish Creek, WI 54212-0067 | 2012-09-12 |
| 1346505708 | Kenneth Lowell Day | Urology | 2603 Teal Ave (residence), Wausau, WI 54401-7162 | 2012-07-11 |
| 1356601587 | Fox Valley Urological Associates Sc | Urology | 2700 E Enterprise Ave Ste A, Appleton, WI 54913-7656 | 2012-05-22 |
| 1730445255 | Anand Patel | Urology | 2424 S 90th St Fl 3, West Allis, WI 53227-2455 | 2012-04-10 |
| 1831486117 | Mary Hallman Leikness | Urology | 358 S. Oxford Street, Pob 207, Wautoma, WI 54982-0000 | 2011-07-07 |
| 1710293105 | Charles Copland Smith | Urology | 674 Sunset Circle, Green Bay, WI 54301 | 2010-08-24 |
| 1689991200 | Sean Brady Mcadams | Urology | 720 S Vanburen Street, Suite 301, Green Bay, WI 54301 | 2010-04-21 |
| 1730404385 | Robert J Hartman Jr. | Urology | 10400 75th St Ste 204, Kenosha, WI 53142-7884 | 2010-04-06 |
| 1588998538 | Gary Melvin Licklider | Urology | 5002 Prairie Rose Ct, Middleton, WI 53562-2385 | 2009-09-23 |
| 1376793240 | Raymond Harkavy | Urology | 9440 N. Broadmoor Road, Milwaukee, WI 53217-1309 | 2008-09-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.