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NPI Code Detail

MEDICARE: GREGORY MATTHEW BOTTEI MD

MEDICARE: GREGORY MATTHEW BOTTEI MD
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
1207R00000XInternal Medicine Physician41784WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245255561
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY MATTHEW BOTTEI MD
Provider Business Mailing Address
First Line : 610 N BROADWAY
Second Line :
City : GREEN BAY
State : WI
Zip : 54303-3426
Country : US
Telephone Number : 920-437-7206
Fax Number :
Provider Business Practice Location Address
First Line : 610 N BROADWAY
Second Line :
City : GREEN BAY
State : WI
Zip : 54303-3426
Country : US
Telephone Number : 920-437-7206
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2006
Last Update Date : 06/11/2024

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