MEDICARE: WISCONSIN VEIN INSTITUTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	43380020	WI

General Provider Information

NPI Number	:	1154516078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISCONSIN VEIN INSTITUTE

Provider Business Mailing Address
First Line	:	1841 S RIDGE RD
Second Line	:	SUITE 2
City	:	GREEN BAY
State	:	WI
Zip	:	54304-3938
Country	:	US
Telephone Number	:	920-884-8346
Fax Number	:

Provider Business Practice Location Address
First Line	:	1841 S RIDGE RD
Second Line	:	SUITE 2
City	:	GREEN BAY
State	:	WI
Zip	:	54304-3938
Country	:	US
Telephone Number	:	920-884-8346
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JAMES V ROBELEN
Credential	:	M.D.
Telephone Number	:	920-884-8346

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	09/13/2007

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Directions to “WISCONSIN VEIN INSTITUTE ” Practice Location

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