Organization
BAYCARE CLINIC LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE HETTMANN (PROVIDER CREDENTIALING COORDINATOR)
(920) 490-9046
Entity
Organization
Contact information
Practice address
630 RIVERFRONT DR, SHEBOYGAN, WI 53081-4615
(920) 682-6376
Mailing address
PO BOX 28900, GREEN BAY, WI 54324-0900
(920) 965-4055
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
Other
Enumeration date
05/28/2020
Last updated
05/28/2020
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