Provider Demographics
NPI:1871812180
Name:WOJTECKI, JEREMY JASON (PA-C)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:JASON
Last Name:WOJTECKI
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S SUNNY SLOPE RD
Mailing Address - Street 2:SUITE 136
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-6461
Mailing Address - Country:US
Mailing Address - Phone:262-786-4550
Mailing Address - Fax:262-786-4552
Practice Address - Street 1:150 S SUNNY SLOPE RD
Practice Address - Street 2:SUITE 136
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-6461
Practice Address - Country:US
Practice Address - Phone:262-786-4550
Practice Address - Fax:262-786-4552
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2577363A00000X
WI2577-023363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1871812180Medicaid
WIK400108854Medicare PIN
WIK400108853Medicare PIN