Healthcare Provider Details

I. General information

NPI: 1629260625
Provider Name (Legal Business Name): BELLIN MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 COMMANCHE AVE
GREEN BAY WI
54313-6089
US

IV. Provider business mailing address

1630 COMMANCHE AVE
GREEN BAY WI
54313-6089
US

V. Phone/Fax

Practice location:
  • Phone: 920-430-4560
  • Fax: 920-430-4558
Mailing address:
  • Phone: 920-430-4560
  • Fax: 920-430-4558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DENISE K STROOBANTS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 920-433-7864