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Organization
GREEN BAY ONCOLOGY, LTD
Active
Organization
GREEN BAY ONCOLOGY, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GINA M MOON (CFO)
(920) 965-9526
Entity
Organization
Contact information
Practice address
1726 SHAWANO AVE, GREEN BAY, WI 54303
(920) 884-3135
(920) 884-3271
Mailing address
1726 SHAWANO AVE., GREEN BAY, WI 54303
(920) 884-3135
(920) 884-3271
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0189920001
DMERC
—
01
—
110B210240
BCBS GROUP
MI
05
—
32769100
—
WI
01
—
O1037
RR MEDICARE
—
Enumeration date
06/16/2006
Last updated
10/28/2014
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