Individual
DR. JONATHAN LEE EICHELSDOERFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1160 KEPLER DR, GREEN BAY, WI 54311-8321
(920) 288-8000
Mailing address
1160 KEPLER DR, GREEN BAY, WI 54311-8321
(920) 288-8000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4351046904
MI
207Q00000X
Family Medicine Physician
Primary
81936
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100244153
—
WI
Enumeration date
06/18/2020
Last updated
12/15/2023
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