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General NPI Number Information
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NPI Number | 1477819902
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Entity Type | Organization
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Legal Business Name | SHEBOYGAN PHYSICIANS GROUP, SC
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 2920 SUPERIOR AVE
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City | SHEBOYGAN
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State | WI
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Zip | 53081-1944
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Country | US
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Telephone | 920-452-6000
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Fax | 920-803-2990
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Provider Business Mailing Address
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Address Line | 2920 SUPERIOR AVE
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City | SHEBOYGAN
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State | WI
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Zip | 53081-1944
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Country | US
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Telephone | 920-452-6000
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Fax | 920-803-2990
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KELLEY RENZELMANN
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Credential |
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Telephone | 920-452-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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