Organization
BAYCARE CLINIC LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRIS JAY AUGUSTIAN C.P.A (CHIEF EXECUTIVE OFFICER)
(920) 405-5382
Entity
Organization
Contact information
Practice address
3117 SHORE DR, 102, MARINETTE, WI 54143-4293
(715) 735-4200
Mailing address
PO BOX 28900, GREEN BAY, WI 54324-0900
(920) 490-9046
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
952
WI
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
08/01/2014
Last updated
04/20/2022
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