Healthcare Provider Details

I. General information

NPI: 1760897912
Provider Name (Legal Business Name): NICHOLAS Z PRYOMSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 SPRING ST
MOUNT PLEASANT WI
53406-2632
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-504-3100
  • Fax:
Mailing address:
  • Phone: 262-504-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number67376
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: