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General NPI Number Information
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NPI Number | 1154400034
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Entity Type | Organization
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Legal Business Name | OB-GYN ASSOC OF GREEN BAY LTD
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 704 S WEBSTER AVE STE 300
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City | GREEN BAY
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State | WI
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Zip | 54301
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Country | US
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Telephone | 920-468-3443
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Fax | 920-432-6313
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Provider Business Mailing Address
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Address Line | 1350 WITTMANN DRIVE HEALTHCARE MANAGEMENT CONSULTANTS
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City | MENASHA
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State | WI
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Zip | 54952-3809
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Country | US
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Telephone | 920-886-6565
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Fax | 920-886-6570
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | ROBERT KNOX DEMOTT
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Credential | MD
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Telephone | 920-468-3443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number |
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207VC0200X
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Taxonomy Name | Critical Care Medicine (Obstetrics & Gynecology) Physician
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License Number |
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License Number State | WI
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