Organization
GREEN BAY EMERGENCY PHYSICIANS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN VAUGHN (OFFICER)
(973) 251-1132
Entity
Organization
Contact information
Practice address
1726 SHAWANO AVE, GREEN BAY, WI 54303-3216
(414) 290-6718
(414) 290-6755
Mailing address
111 E WISCONSIN AVE, SUITE 2000, MILWAUKEE, WI 53202-4815
(414) 290-6718
(414) 290-6755
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020151500
FEDERAL BLACK LUNG PROGRA
WI
01
—
120003951
WEA
WI
01
—
137598401
OWCP
WI
05
—
32875300
—
WI
01
—
CI8038
MEDICARE RAILROAD
WI
Enumeration date
05/05/2006
Last updated
02/08/2024
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