Organization
GREEN BAY CARDIOTHORACIC & VASCULAR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY JO HOLEWINSKI (OFFICE MANAGER)
(920) 433-9621
Entity
Organization
Contact information
Practice address
1711 S STEPHENSON AVE, IRON MOUNTAIN, MI 49801-3639
(920) 433-9621
(920) 433-0565
Mailing address
720 S VANBUREN STREET, SUITE 303, GREEN BAY, WI 54301
(920) 433-9621
(920) 433-0565
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659412401
MEDICARE NPI
WI
05
—
32897600
—
WI
Enumeration date
01/14/2009
Last updated
01/16/2009
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