Organization
BELLIN MEMORIAL HOSPITAL INC
Active
Other names
FMC Ashwaubenon Internal Medicine & Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE K STROOBANTS (CREDENTIALING SPECIALIST)
(920) 433-7864
Entity
Organization
Contact information
Practice address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-6089
(920) 497-7771
Mailing address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-6089
(920) 497-7771
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52D0907183
CLIA #
WI
Enumeration date
04/06/2006
Last updated
10/18/2021
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