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Otolaryngology in Green Bay, WI. Organization (NPI-2).

NPI number1861691149
StatusActive
Last updated in NPPESNov 3, 2010

Details

NPI
1861691149
Entity type
Organization (NPI-2)
Legal business name
New Ent Sc
Organization subpart
No
Enumeration date
Jul 16, 2007
Last updated
Nov 3, 2010

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Y00000X Otolaryngology––Yes

Practice location

923 Eliza St
Green Bay, WI 54301-3234

Phone 920-965-4800 · Fax 920-431-7024

Mailing address

923 Eliza St
Green Bay, WI 54301-3234

Phone 920-965-4800 · Fax 920-431-7024

Authorized official

Sally Jilot
Administrator
9209654800

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