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General NPI Number Information
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NPI Number | 1558796490
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Entity Type | Organization
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Legal Business Name | JAMES E MEMMEN MD LIMITED
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Dates
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Enumeration Date | 09/11/2013
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 1543 PARK PL STE 400
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City | GREEN BAY
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State | WI
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Zip | 54304-1970
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Country | US
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Telephone | 920-497-0100
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Fax | 920-497-0101
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Provider Business Mailing Address
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Address Line | PO BOX 10946
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City | GREEN BAY
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State | WI
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Zip | 54307-0946
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Country | US
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Telephone | 920-380-0100
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Fax | 920-380-0101
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES E MEMMEN
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Credential | MD
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Telephone | 920-380-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2918320
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License Number State | WI
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