Healthcare Provider Details

I. General information

NPI: 1962347641
Provider Name (Legal Business Name): CUSTOMIZED HEALTH CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 PACKERLAND DR STE D1
GREEN BAY WI
54303-4862
US

IV. Provider business mailing address

108 PACKERLAND DR STE D1
GREEN BAY WI
54303-4862
US

V. Phone/Fax

Practice location:
  • Phone: 920-545-5109
  • Fax: 920-593-9159
Mailing address:
  • Phone: 920-545-5109
  • Fax: 920-593-9159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN WOODBRIDGE
Title or Position: OWNER
Credential: MD
Phone: 920-545-5109