Organization
NEW ENT SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SALLY JILOT (ADMINISTRATOR)
(920) 965-4800
Entity
Organization
Contact information
Practice address
923 ELIZA ST, GREEN BAY, WI 54301-3234
(920) 965-4800
(920) 431-7024
Mailing address
923 ELIZA ST, GREEN BAY, WI 54301-3234
(920) 965-4800
(920) 431-7024
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000007105
MEDICARE GROUP
WI
01
—
32899300
WMAP GROUP
WI
01
—
4330670001
ADMINASTAR FEDERAL REGION
WI
01
—
CJ2834
MEDICARE RR GROUP
WI
Enumeration date
07/16/2007
Last updated
11/03/2010
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