Individual
BARRY V BAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7326 CR JJ, MANITOWOC, WI 54220-7316
(920) 973-3089
(920) 682-0888
Mailing address
PO BOX 1897, MANITOWOC, WI 54221-1897
(920) 973-3089
(920) 682-0888
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
16625
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31124900
T19 MANAGED HEALTH SERVIC
WI
05
—
31124900
—
WI
Enumeration date
08/21/2006
Last updated
05/20/2013
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