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Physicians Orthopaedic Surgery Hand Surgery

Provider NPI: 1174566194

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
1970 S RIDGE RD  GREEN BAY, WI 54304-4125 US
Tel: 920-430-4888  Fax: 920-430-4889

Business Mailing Address:
744 S WEBSTER AVE  GREEN BAY, WI 54301-3505 US
Tel: 920-445-7222  Fax: 920-445-7289

NPI Information:
NPI: 1174566194
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Orthopaedic Surgery
Hand Surgery

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 207XS0106X





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