Provider Demographics
NPI:1396629770
Name:PECORARO, NICHOLAS ELI
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ELI
Last Name:PECORARO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W376S5119 E PRETTY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DOUSMAN
Mailing Address - State:WI
Mailing Address - Zip Code:53118-8709
Mailing Address - Country:US
Mailing Address - Phone:312-399-3272
Mailing Address - Fax:
Practice Address - Street 1:W376S5119 E PRETTY LAKE RD
Practice Address - Street 2:
Practice Address - City:DOUSMAN
Practice Address - State:WI
Practice Address - Zip Code:53118-8709
Practice Address - Country:US
Practice Address - Phone:312-399-3272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program