Healthcare Provider Details

I. General information

NPI: 1073635157
Provider Name (Legal Business Name): ROBERT MICHAEL ROCK JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 S. VANBUREN ST.
GREEN BAY WI
54301
US

IV. Provider business mailing address

P.O. BOX 57 NEONATAL CONSULTANTS
DEPERE WI
54115
US

V. Phone/Fax

Practice location:
  • Phone: 920-433-8360
  • Fax: 920-431-3163
Mailing address:
  • Phone: 920-983-9401
  • Fax: 920-983-9402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number54182
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: