Healthcare Provider Details

I. General information

NPI: 1891740262
Provider Name (Legal Business Name): DIVYA HOTCHANDANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 GREENBRIER RD
GREEN BAY WI
54311-6519
US

IV. Provider business mailing address

164 N BROADWAY
GREEN BAY WI
54303-2728
US

V. Phone/Fax

Practice location:
  • Phone: 920-288-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number66339
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME98667
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: