Individual
MARK KURT VILLWOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3021 VOYAGER DR, GREEN BAY, WI 54311-8303
(920) 496-4700
(920) 272-1573
Mailing address
PO BOX 19070, PREVEA HEALTH, GREEN BAY, WI 54307-9070
(920) 496-4700
(920) 272-1573
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25474
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30575900
—
WI
Enumeration date
07/18/2006
Last updated
07/22/2008
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