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General NPI Number Information
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NPI Number | 1003337809
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Entity Type | Individual
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Provider Name | ANDREW JOHN VANBRUGGEN DO
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Gender | Male
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Dates
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Enumeration Date | 06/30/2017
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Last Update Date | 12/07/2022
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Provider Practice Location Address
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Address Line | 2654 S ONEIDA ST STOP 102
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City | GREEN BAY
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State | WI
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Zip | 54304-5337
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Country | US
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Telephone | 888-938-3838
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Fax | 888-919-1083
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Provider Business Mailing Address
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Address Line | 10001 W INNOVATION DR STE 200
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City | MILWAUKEE
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State | WI
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Zip | 53226-4851
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Country | US
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Telephone | 888-938-3838
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Fax | 888-919-1083
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 2017018862
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 69733
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 77450
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License Number State | WI
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