Individual
WILLIAM G SYBESMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
865 MULLEN DR, FOND DU LAC, WI 54935-6437
(920) 744-8147
Mailing address
865 MULLEN DR, FOND DU LAC, WI 54935-6437
(920) 744-4187
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
21464
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040008752
RAILROAD MEDICARE
WI
01
—
12573
DEAN
WI
05
—
30172100
—
WI
01
—
39080723648
UNITY
WI
01
—
WI0156
JOHN DEERE
WI
Enumeration date
11/21/2005
Last updated
09/11/2009
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