| NPI | 1770558066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESANNE JOHNSON Office Manager 920-563-7711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2025-09-11 |