Healthcare Provider Details

I. General information

NPI: 1831486828
Provider Name (Legal Business Name): AARON H BUBOLZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 GREENBRIER RD 1ST FLOOR
GREEN BAY WI
54311-6519
US

IV. Provider business mailing address

2845 GREENBRIER RD 1ST FLOOR
GREEN BAY WI
54311-6519
US

V. Phone/Fax

Practice location:
  • Phone: 920-288-8100
  • Fax: 920-288-8668
Mailing address:
  • Phone: 920-288-8100
  • Fax: 920-288-8668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number65891
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: