Individual
MICHELLE LYN MINIKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
704 S WEBSTER AVE, SUITE 200, GREEN BAY, WI 54301-3528
(920) 433-3456
(920) 433-3469
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
64141-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093913113
—
WI
05
—
807771900
—
ID
Enumeration date
07/10/2007
Last updated
06/12/2019
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