Healthcare Provider Details

I. General information

NPI: 1427007624
Provider Name (Legal Business Name): HERBERT S COUSSONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 HOLMGREN WAY
GREEN BAY WI
54304-5224
US

IV. Provider business mailing address

2411 HOLMGREN WAY
GREEN BAY WI
54304-5224
US

V. Phone/Fax

Practice location:
  • Phone: 920-888-2828
  • Fax: 888-876-4773
Mailing address:
  • Phone: 920-888-2828
  • Fax: 888-876-4773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number43795-020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberM-7022
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number43795-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: