Organization
ST GIANNA MOLLA CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN GOLDSMITH (PRESIDENT/CHIEF MEDICAL OFFICER)
(920) 716-1451
Entity
Organization
Contact information
Practice address
1716 LAWRENCE DR STE 100, DE PERE, WI 54115-9108
(920) 605-3115
(920) 486-6826
Mailing address
1716 LAWRENCE DR STE 100, DE PERE, WI 54115-9108
(920) 605-3115
(920) 486-6826
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100163645
—
WI
Enumeration date
10/27/2020
Last updated
04/05/2023
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