Healthcare Provider Details

I. General information

NPI: 1528603537
Provider Name (Legal Business Name): ERIK UHL LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 S RIDGE RD
GREEN BAY WI
54304-4125
US

IV. Provider business mailing address

151 CUSTER CT
GREEN BAY WI
54301-1242
US

V. Phone/Fax

Practice location:
  • Phone: 920-430-4888
  • Fax:
Mailing address:
  • Phone: 906-458-4865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1990
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: