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NPI Code Detail

MEDICARE: DIANNA L BORDEWICK MD

MEDICARE: DIANNA L BORDEWICK 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
1207W00000XOphthalmology Physician41090WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2180043984OTHERWIRAILROAD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790720100
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANNA L BORDEWICK MD
Provider Business Mailing Address
First Line : 2253 W MASON ST STE 100
Second Line : PO BOX 13097
City : GREEN BAY
State : WI
Zip : 54307-3097
Country : US
Telephone Number : 920-327-7000
Fax Number : 920-327-7005
Provider Business Practice Location Address
First Line : 2253 W MASON ST STE 100
Second Line :
City : GREEN BAY
State : WI
Zip : 54303-4706
Country : US
Telephone Number : 920-327-7000
Fax Number : 920-327-7005
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2006
Last Update Date : 08/28/2008

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Directions to “ DIANNA L BORDEWICK MD” Practice Location

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