Healthcare Provider Details

I. General information

NPI: 1346476066
Provider Name (Legal Business Name): LUKASZ S BABIARZ M.D., M.B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 S WEBSTER AVE
GREEN BAY WI
54301-3505
US

IV. Provider business mailing address

1789 SHAWANO AVE
GREEN BAY WI
54303-3243
US

V. Phone/Fax

Practice location:
  • Phone: 920-433-3500
  • Fax:
Mailing address:
  • Phone: 920-499-1428
  • Fax: 920-499-7080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number63735
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301500785
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number63735-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: