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General NPI Number Information
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NPI Number | 1568962678
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Entity Type | Organization
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Legal Business Name | BAYCARE CLINIC, LLP
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Dates
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Enumeration Date | 02/15/2018
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Last Update Date | 04/20/2022
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Provider Practice Location Address
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Address Line | 3003 UNIVERSITY DR
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City | MARINETTE
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State | WI
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Zip | 54143-4110
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Country | US
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Telephone | 920-490-9046
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 28900
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City | GREEN BAY
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State | WI
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Zip | 54324-0900
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Country | US
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Telephone | 920-490-9046
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Fax |
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Authorized Official
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Title or Position | PROVIDER CREDENTIALING COORDINATOR
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Name | NICOLE M HETTMANN
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Credential |
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Telephone | 920-490-9046
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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