Individual
DR. GREGORY SHOICHI ISHIMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4100 DEWEY ST, MANITOWOC, WI 54220-5497
(805) 624-0615
Mailing address
4100 DEWEY ST, MANITOWOC, WI 54220-5497
(805) 624-0615
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
56106-020
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/06/2008
Last updated
08/29/2011
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