Organization
BAYCARE CLINIC, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE HETTMANN (PROVIDER CREDENTIALING COORDINATOR)
(920) 490-9046
Entity
Organization
Contact information
Practice address
2353 S RIDGE RD, GREEN BAY, WI 54304-5069
(920) 490-9046
Mailing address
PO BOX 28900, GREEN BAY, WI 54324-0900
(920) 490-9046
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
208200000X
Plastic Surgery Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
12/26/2017
Last updated
04/20/2022
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