Organization
PREVEA CLINIC, INC.
Active
Other names
Prevea Health
Organization subpart
No
Provider details
NPI number
Authorized official
ASHOK N RAI MD (PRESIDENT/CEO)
(920) 496-4700
Entity
Organization
Contact information
Practice address
2710 EXECUTIVE DR, GREEN BAY, WI 54304-5496
(920) 496-4700
(920) 496-4705
Mailing address
PO BOX 19070, PREVEA HEALTH, GREEN BAY, WI 54307-9070
(920) 496-4700
(920) 496-4705
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207VX0201X
Gynecologic Oncology Physician
—
—
207W00000X
Ophthalmology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
—
208000000X
Pediatrics Physician
—
—
2080P0201X
Pediatric Allergy/Immunology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32704600
—
WI
Enumeration date
07/25/2006
Last updated
01/12/2022
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