Provider Demographics
NPI:1891802286
Name:PELEGRIN, JODI ANN (DO)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:ANN
Last Name:PELEGRIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:ANN
Other - Last Name:PELEGRIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:JODI ANN BLADES
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53082-0959
Mailing Address - Country:US
Mailing Address - Phone:920-686-2333
Mailing Address - Fax:
Practice Address - Street 1:2719 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-5546
Practice Address - Country:US
Practice Address - Phone:920-686-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42297-21207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04515143OtherBCBS#
IL0727500001Medicare NSC
ILK45009Medicare PIN
G85645Medicare UPIN
ILK45010Medicare PIN