Healthcare Provider Details

I. General information

NPI: 1912932823
Provider Name (Legal Business Name): PETER M STANKO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 SHAWANO AVE
GREEN BAY WI
54303-3216
US

IV. Provider business mailing address

3301 W FOREST HOME AVE
MILWAUKEE WI
53215-2843
US

V. Phone/Fax

Practice location:
  • Phone: 920-496-4700
  • Fax: 920-429-1799
Mailing address:
  • Phone: 414-525-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number41493
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: