Healthcare Provider Details

I. General information

NPI: 1497783641
Provider Name (Legal Business Name): ROBERT W BJORAKER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
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 PO BOX 8900
GREEN BAY WI
54303-2728
US

V. Phone/Fax

Practice location:
  • Phone: 920-288-3388
  • Fax: 920-288-3370
Mailing address:
  • Phone: 920-965-4065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number43652
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: