Healthcare Provider Details

I. General information

NPI: 1366470551
Provider Name (Legal Business Name): DANZHU GUO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 HOLMGREN WAY
GREEN BAY WI
54304-5224
US

IV. Provider business mailing address

1035 KEPLER DR
GREEN BAY WI
54311-8320
US

V. Phone/Fax

Practice location:
  • Phone: 920-288-8377
  • Fax: 920-288-8385
Mailing address:
  • Phone: 920-490-9046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number43199
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: