| NPI | 1568962678 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE M HETTMANN Provider Credentialing Coordinator 920-490-9046 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease |
| Additional Taxonomies | 207Y00000X Otolaryngology |
| 208100000X Physical Medicine & Rehabilitation | |
| 207T00000X Neurological Surgery | |
| 207X00000X Orthopaedic Surgery | |
| 208200000X Plastic Surgery | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2018-02-15 |
| Last Update Date | 2022-04-20 |