Individual
DR. EDGAR J MASSABNI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3100 SHORE DR, MARINETTE, WI 54143-4242
(715) 735-8067
(715) 732-8224
Mailing address
744 S WEBSTER AVE, GREEN BAY, WI 54301-3505
(920) 445-7226
(920) 445-7229
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
4301093535
MI
207RC0000X
Cardiovascular Disease Physician
51186-20
WI
207RI0011X
Interventional Cardiology Physician
Primary
51186
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007100492
MEDICARE PTAN
WI
Enumeration date
04/25/2006
Last updated
03/30/2020
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