Healthcare Provider Details

I. General information

NPI: 1518134980
Provider Name (Legal Business Name): BESIADA HEALTH INNOVATORS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SHAWANO AVE STE 106E
GREEN BAY WI
54303-3246
US

IV. Provider business mailing address

1600 SHAWANO AVE SUITE 106E
GREEN BAY WI
54303-3246
US

V. Phone/Fax

Practice location:
  • Phone: 920-491-9079
  • Fax: 920-491-9082
Mailing address:
  • Phone: 920-491-9079
  • Fax: 920-491-9082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: KAREN BESIADA HANSEN
Title or Position: OWNER
Credential: OTR
Phone: 920-491-9079