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DIANNA L BORDEWICK MD

Physicians Ophthalmology

Provider NPI: 1790720100

Provider Information:
 DIANNA L BORDEWICK MD
Gender: F
Not Sole Proprietor

Practice Location:
2253 W MASON ST STE 100  GREEN BAY, WI 54303-4706 US
Tel: 920-327-7000  Fax: 920-327-7005

Business Mailing Address:
2253 W MASON ST STE 100 PO BOX 13097 GREEN BAY, WI 54307-3097 US
Tel: 920-327-7000  Fax: 920-327-7005

NPI Information:
NPI: 1790720100
Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207W00000XPhysicians
Ophthalmology
WI41090

Other Provider Identifiers:

IssuerNumberStateType
RAILROAD180043984WI01
32562600WI05
104390165MI05



American Medical Association 2012 taxonomy code information

Code: 207W00000X

Type:

Classification:



Definition:



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