Healthcare Provider Details

I. General information

NPI: 1679531529
Provider Name (Legal Business Name): GOPE C HOTCHANDANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2771 RAMADA WAY
GREEN BAY WI
54304-5759
US

IV. Provider business mailing address

2771 RAMADA WAY
GREEN BAY WI
54304-5759
US

V. Phone/Fax

Practice location:
  • Phone: 920-497-9996
  • Fax: 920-497-9908
Mailing address:
  • Phone: 920-497-9996
  • Fax: 920-497-9908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number41587020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: