Organization
NEW MOM'S OF GREEN BAY SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLAHYAR JAZAYERI M.D. (PRESIDENT/OWNER)
(920) 338-6868
Entity
Organization
Contact information
Practice address
704 S WEBSTER AVE STOP 110, GREEN BAY, WI 54301-3528
(920) 431-0200
(920) 431-0300
Mailing address
704 S WEBSTER AVE STOP 110, GREEN BAY, WI 54301-3528
(920) 431-0200
(920) 431-0300
Taxonomy
Speciality
Code
Description
License number
State
207VM0101X
Maternal & Fetal Medicine Physician
Primary
44616020
WI
261Q00000X
Clinic/Center
44616020
WI
Other
Enumeration date
04/11/2008
Last updated
12/04/2009
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