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Individual

SALLY SCHLISE

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
835 S VAN BUREN ST, GREEN BAY, WI 54301-3526
(920) 433-8184
Mailing address
11516 N PORT WASHINGTON RD, STE 202, MEQUON, WI 53092-3441

Taxonomy

Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
21935
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
30362700
WI
Enumeration date
06/09/2006
Last updated
07/08/2007
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