Organization
BAYCARE CLINIC LLP
Active
Organization
BAYCARE CLINIC LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAYLOR KONKLE (PAYOR ENROLLMENT)
(920) 301-1327
Entity
Organization
Contact information
Practice address
930 MARITIME DR, MANITOWOC, WI 54220-2961
(920) 682-9121
(920) 682-7188
Mailing address
PO BOX 28900, GREEN BAY, WI 54324-0900
(920) 490-9046
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
01/13/2012
Last updated
08/27/2026
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