Individual
EDGAR (TED) KING COLLISON IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1715 DOUSMAN ST, GREEN BAY, WI 54303-3211
(920) 496-4700
Mailing address
1715 DOUSMAN ST, GREEN BAY, WI 54303-3211
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
336.084547
IL
208600000X
Surgery Physician
Primary
54369-020
WI
Other
Enumeration date
01/29/2010
Last updated
12/16/2021
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