Organization
GBR SHEBOYGAN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIMMY DADO CFO (AUTHORIZED OFFICAL)
(614) 325-8899
Entity
Organization
Contact information
Practice address
3100 SUPERIOR AVE, SHEBOYGAN, WI 53081-1948
(920) 964-0480
(920) 336-8093
Mailing address
2941 S RIDGE RD, GREEN BAY, WI 54304-5517
(920) 336-4096
(920) 336-8093
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
WI
2085R0204X
Vascular & Interventional Radiology Physician
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21284500
—
WI
Enumeration date
11/29/2006
Last updated
03/19/2024
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