| NPI | 1376594952 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE BOYD Credentialing Specialist 920-358-1729 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 2086S0129X |
| 2086X0206X Surgery, Surgical Oncology | |
| 207RG0100X Internal Medicine, Gastroenterology | |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2025-08-11 |