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General NPI Number Information
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NPI Number | 1154516078
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Entity Type | Organization
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Legal Business Name | WISCONSIN VEIN INSTITUTE
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 09/13/2007
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Provider Practice Location Address
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Address Line | 1841 S RIDGE RD SUITE 2
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City | GREEN BAY
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State | WI
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Zip | 54304-3938
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Country | US
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Telephone | 920-884-8346
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Fax |
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Provider Business Mailing Address
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Address Line | 1841 S RIDGE RD SUITE 2
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City | GREEN BAY
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State | WI
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Zip | 54304-3938
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Country | US
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Telephone | 920-884-8346
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JAMES V ROBELEN
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Credential | M.D.
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Telephone | 920-884-8346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 43380020
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License Number State | WI
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