Individual
HEIDI BLANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
835 S VAN BUREN ST, GREEN BAY, WI 54301-3526
(920) 433-0111
Mailing address
835 S VAN BUREN ST, GREEN BAY, WI 54301-3526
(920) 433-0111
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
73115-20
WI
282N00000X
General Acute Care Hospital
—
—
Other
Enumeration date
06/29/2015
Last updated
12/23/2021
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