Organization
MILLENIUM ANESTHESIOLOGISTS, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES R HERON M.D. (PRESIDENT)
(920) 498-4200
Entity
Organization
Contact information
Practice address
1726 SHAWANO AVE, GREEN BAY, WI 54303-3216
(920) 498-4200
Mailing address
225 S EXECUTIVE DR, BROOKFIELD, WI 53005-4266
(262) 787-4026
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21302500
—
WI
Enumeration date
11/25/2006
Last updated
12/18/2014
Update your record
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