Individual
AHMET DERVISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2845 GREENBRIER RD STE 340, GREEN BAY, WI 54311-6519
(920) 288-8380
(920) 288-8385
Mailing address
2845 GREENBRIER RD STE 340, PO BOX 8900, GREEN BAY, WI 54308-8900
(920) 288-8380
(920) 288-8385
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
33794
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050080452
RAILROAD
WI
05
—
104365449
—
MI
05
—
32021400
—
WI
Enumeration date
06/28/2006
Last updated
08/29/2008
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