Healthcare Provider Details

I. General information

NPI: 1649895228
Provider Name (Legal Business Name): KEAGAN TIMOTHY GERTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2223 LIME KILN RD
GREEN BAY WI
54311-6234
US

IV. Provider business mailing address

2223 LIME KILN RD STE 1
GREEN BAY WI
54311-6238
US

V. Phone/Fax

Practice location:
  • Phone: 920-430-8113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number87333-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: