Healthcare Provider Details

I. General information

NPI: 1821476805
Provider Name (Legal Business Name): AUSTIN GREENWOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3263 EATON ROAD
GREEN BAY WI
54311-8046
US

IV. Provider business mailing address

2400 W VILLARD AVE
MILWAUKEE WI
53209-4901
US

V. Phone/Fax

Practice location:
  • Phone: 920-433-6700
  • Fax:
Mailing address:
  • Phone: 414-527-8191
  • Fax: 414-527-8046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number81292-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: