Healthcare Provider Details

I. General information

NPI: 1841022035
Provider Name (Legal Business Name): PATRICK MATTHEW MANYEK PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PATRICK MATTHEW MANYEK PA-C

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 WATERTOWN PLANK RD
MILWAUKEE WI
53226-3548
US

IV. Provider business mailing address

201 ABRAHAM FLEXNER WAY STE 1200
LOUISVILLE KY
40202-3841
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-8296
  • Fax:
Mailing address:
  • Phone: 502-588-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTC1963
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: