Individual
BENJAMIN MICHAEL MOREAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1970 S RIDGE RD, GREEN BAY, WI 54304-4125
(920) 430-4888
(920) 430-4889
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7210
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5601011806
MI
363A00000X
Physician Assistant
Primary
7440-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1202461
NAT'L COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS
WI
Enumeration date
05/10/2023
Last updated
08/31/2023
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