Healthcare Provider Details

I. General information

NPI: 1417082629
Provider Name (Legal Business Name): NEONATAL CONSULTANTS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 S VAN BUREN ST
GREEN BAY WI
54301-3526
US

IV. Provider business mailing address

PO BOX 57
DE PERE WI
54115-0057
US

V. Phone/Fax

Practice location:
  • Phone: 920-983-9401
  • Fax: 920-983-9408
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 Number
License Number State

VIII. Authorized Official

Name: CHERYL SERVAIS
Title or Position: BILLING MANAGER
Credential:
Phone: 920-983-9401