MEDICARE: PAYDEN WHITE

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	207V00000X	Obstetrics & Gynecology Physician	DR.0075665	CO
2	207V00000X	Obstetrics & Gynecology Physician	86918	WI

General Provider Information

NPI Number	:	1477133684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAYDEN WHITE

Provider Business Mailing Address
First Line	:	744 S WEBSTER AVE
Second Line	:	MEDICAL STAFF SERVICES
City	:	GREEN BAY
State	:	WI
Zip	:	54301-3505
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2641 DEVELOPMENT DR
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-4240
Country	:	US
Telephone Number	:	920-338-6868
Fax Number	:	920-338-6869

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2021
Last Update Date	:	06/16/2026

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2641 DEVELOPMENT DR
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1871263038 — PAMELA S GEOCARIS RN, CPSN, CSFA
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1780675603 — MRS. HEATHER RIESSLAND ALLEN P.A
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1831116797 — STEVEN C SCHMIDT MD
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Directions to “ PAYDEN WHITE ” Practice Location

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