Individual
SHANE J DEGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-6089
(920) 430-4700
Mailing address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-6089
(920) 430-4700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
47641
MN
207Q00000X
Family Medicine Physician
Primary
50647 - 020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
241127000
—
MN
Enumeration date
01/03/2006
Last updated
10/07/2011
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