Individual
JEFFREY M BASTASIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
878 W AIRPORT RD, MENASHA, WI 54952-1461
(920) 727-5982
Mailing address
878 W AIRPORT RD, MENASHA, WI 54952-1461
(920) 727-5982
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
52366
WI
Other
Enumeration date
03/21/2007
Last updated
01/06/2021
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