Individual
DR. EDMUND S. FANGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
835 S VAN BUREN ST, GREEN BAY, WI 54301-3526
(920) 433-0111
Mailing address
225 S EXECUTIVE DR, BROOKFIELD, WI 53005-4266
(262) 787-4026
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
45525-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34555400
—
WI
01
—
P00140551
RAIL ROAD MEDICARE
—
Enumeration date
11/25/2005
Last updated
12/28/2021
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