MEDICARE: PAULA ZDANOWSKI PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	085008439	IL
2	363A00000X	Physician Assistant	5549	WI
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1720671738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA ZDANOWSKI PA-C

Provider Business Mailing Address
First Line	:	2350 N LAKE DR
Second Line	:	STE 400
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-4528
Country	:	US
Telephone Number	:	414-270-1633
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 NORTH 17TH STREET
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53233-0037
Country	:	US
Telephone Number	:	414-288-5688
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2021
Last Update Date	:	03/19/2026

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