Healthcare Provider Details

I. General information

NPI: 1386600666
Provider Name (Legal Business Name): BRUCE R DANZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E 12TH ST
KAUKAUNA WI
54130-2865
US

IV. Provider business mailing address

305 E 12TH ST
KAUKAUNA WI
54130-2865
US

V. Phone/Fax

Practice location:
  • Phone: 920-766-4656
  • Fax: 920-766-4659
Mailing address:
  • Phone: 920-766-4656
  • Fax: 920-766-4659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0024090
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: