Individual
TIMM SCOTT MISSBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-6089
(920) 430-4585
Mailing address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-6089
(920) 430-4585
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
38166
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32284100
—
WI
Enumeration date
07/09/2006
Last updated
02/27/2014
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