Healthcare Provider Details

I. General information

NPI: 1790711299
Provider Name (Legal Business Name): EDWARD M WINECK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E THIRD STREET
DULUTH MN
55805-1951
US

IV. Provider business mailing address

2845 GREENBRIER RD PO BOX 8900
GREEN BAY WI
54308-8900
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-8364
  • Fax:
Mailing address:
  • Phone: 920-288-4930
  • Fax: 920-288-4941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number40390
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: