Organization
GREEN BAY ANESTHESIA ASSOC. SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN B SKALETSKI M.D. (AUTHORIZED OFFICIAL)
(920) 433-0111
Entity
Organization
Contact information
Practice address
835 S VAN BUREN ST, GREEN BAY, WI 54301-3526
(920) 433-0111
Mailing address
225 S EXECUTIVE DR, BROOKFIELD, WI 53005-4257
(262) 787-4026
(262) 782-6040
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32797400
—
WI
Enumeration date
05/27/2006
Last updated
09/02/2011
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