Individual
TIMOTHY EDWARD TANKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
744 S WEBSTER AVE, 2ND FL, GREEN BAY, WI 54301-3505
(920) 433-3640
(920) 433-3705
Mailing address
744 S WEBSTER AVE, 2ND FL, GREEN BAY, WI 54301-3505
(920) 433-3640
(920) 433-3705
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
36179
WI
207RI0011X
Interventional Cardiology Physician
36179-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32340100
—
WI
Enumeration date
07/18/2006
Last updated
12/20/2018
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