Organization
GREAT LAKES HEART AND VASCULAR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDGAR J MASSABNI MD (PRESIDENT)
(715) 735-8067
Entity
Organization
Contact information
Practice address
3100 SHORE DR, MARINETTE, WI 54143-4242
(715) 735-8067
Mailing address
3205 LIBERTY BELL RD, GREEN BAY, WI 54313-6992
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Enumeration date
05/19/2010
Last updated
05/19/2010
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