Individual
SHAMOON MIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3059 VOYAGER DR, GREEN BAY, WI 54311-8303
(920) 965-0345
Mailing address
3059 VOYAGER DR, GREEN BAY, WI 54311-8303
(920) 965-0345
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
853023
WI
Other
Enumeration date
12/09/2024
Last updated
10/03/2025
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