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Organization
BAYCARE CLINIC, LLP
Active
Organization
BAYCARE CLINIC, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAYLOR KONKLE (PAYOR ENROLLMENT)
(920) 301-1327
Entity
Organization
Contact information
Practice address
636 N 12TH AVE, STURGEON BAY, WI 54235-1249
(920) 743-2001
Mailing address
PO BOX 28900, GREEN BAY, WI 54324-0900
(920) 490-9046
(920) 405-5388
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
04/27/2018
Last updated
08/27/2026
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