Individual
IZABELA J DITCHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2714 RIVERVIEW DR, GREEN BAY, WI 54313-6715
(920) 430-4760
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
45158
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34321800
—
WI
01
—
45158
LICENSE
WI
Enumeration date
12/05/2005
Last updated
12/17/2018
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