Healthcare Provider Details

I. General information

NPI: 1699966499
Provider Name (Legal Business Name): BOGDAN CRISTESCU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 GREENBRIER RD
GREEN BAY WI
54308-8900
US

IV. Provider business mailing address

2845 GREENBRIER RD P.O. BOX 8900
GREEN BAY WI
54308-8900
US

V. Phone/Fax

Practice location:
  • Phone: 920-288-8100
  • Fax: 920-288-8152
Mailing address:
  • Phone: 920-288-8100
  • Fax: 920-288-8152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number43654-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: