Healthcare Provider Details

I. General information

NPI: 1851365910
Provider Name (Legal Business Name): JERRY M WINKLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 SHAWANO AVE
GREEN BAY WI
54303-3216
US

IV. Provider business mailing address

1726 SHAWANO AVE
GREEN BAY WI
54303-3216
US

V. Phone/Fax

Practice location:
  • Phone: 920-884-3135
  • Fax: 920-884-3144
Mailing address:
  • Phone: 920-884-3135
  • Fax: 920-884-3144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number43861-020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number4301089576
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036171081
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License Number43861-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: