Edward J Bongiorno, DO
Internal Medicine in Green Bay, WI. Individual provider (NPI-1).
NPI number1992789754
StatusActive
Last updated in NPPESFeb 27, 2014
Details
- NPI
- 1992789754
- Entity type
- Individual (NPI-1)
- Name
- Edward J Bongiorno
- Credential
- DO
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Dec 5, 2005
- Last updated
- Feb 27, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | 4508 | WI | Yes |
| 208000000X | Pediatrics | 45808 | WI | |
| 207Q00000X | Family Medicine | 45808 | WI |
Practice location
1630 Commanche AveGreen Bay, WI 54313-5753
Phone 920-430-4700
Mailing address
1630 Commanche AveGreen Bay, WI 54313-5753
Phone 920-430-4700
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