Individual
EDWARD J BONGIORNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-5753
(920) 430-4700
Mailing address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-5753
(920) 430-4700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
45808
WI
207R00000X
Internal Medicine Physician
Primary
4508
WI
208000000X
Pediatrics Physician
45808
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43507600
—
WI
Enumeration date
12/05/2005
Last updated
02/27/2014
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