Healthcare Provider Details

I. General information

NPI: 1386807170
Provider Name (Legal Business Name): INES C PACURAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 10/15/2023
Certification Date: 10/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2253 W MASON ST
GREEN BAY WI
54303-4706
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 920-327-7300
  • Fax:
Mailing address:
  • Phone: 920-327-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number51820-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: