Healthcare Provider Details

I. General information

NPI: 1487602330
Provider Name (Legal Business Name): JAMES G SACCOMANDO JR. MD, PC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E SAINT JOSEPH ST
GREEN BAY WI
54301-2241
US

IV. Provider business mailing address

3916 N POTSDAM AVE # 61
SIOUX FALLS SD
57104-7048
US

V. Phone/Fax

Practice location:
  • Phone: 920-433-3630
  • Fax:
Mailing address:
  • Phone: 208-866-8330
  • Fax: 208-213-1542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number103898-875
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number61313854
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberM9565
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number61313854
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101280875
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberM9565
License Number StateID
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD478082
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: