Healthcare Provider Details

I. General information

NPI: 1073513974
Provider Name (Legal Business Name): ALLAN RICHARD PASCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 S LAKE DR
CUDAHY WI
53110-3171
US

IV. Provider business mailing address

5900 S LAKE DR
CUDAHY WI
53110-3171
US

V. Phone/Fax

Practice location:
  • Phone: 414-489-4190
  • Fax: 414-332-1005
Mailing address:
  • Phone: 414-489-4190
  • Fax: 414-332-1005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number27484
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number27484
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: