Individual
DR. ERIC MAITLAND DVORAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
744 S WEBSTER AVE, GREEN BAY, WI 54305-2487
(920) 445-7210
(920) 445-7229
Mailing address
PO BOX 23400, GREEN BAY, WI 54305-2340
(920) 445-7210
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
49884-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003986845
—
WI
Enumeration date
11/09/2006
Last updated
05/06/2015
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