Organization
HEART AND VASCULAR OF WISCONSIN, SC
Active
Organization
HEART AND VASCULAR OF WISCONSIN, SC
Active
Other names
Heart and Vascular Institute of Wisconsin
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY SOBAL (CEO)
(904) 574-6211
Entity
Organization
Contact information
Practice address
5045 W GRANDE MARKET DR, APPLETON, WI 54913-8517
(920) 886-9380
(920) 886-9381
Mailing address
PO BOX 610, GREEN BAY, WI 54305-0610
(920) 886-9380
(920) 886-9381
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100088147
—
WI
Enumeration date
01/08/2019
Last updated
10/24/2022
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