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NPI Code Detail

MEDICARE: DR. FRED WALBRUN MD

MEDICARE: DR. FRED WALBRUN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0300XGeriatric Medicine (Internal Medicine) Physician22566WI

General Provider Information

NPI Number : 1306848700
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FRED WALBRUN MD
Provider Business Mailing Address
First Line : PO BOX 19070
Second Line :
City : GREEN BAY
State : WI
Zip : 54307-9070
Country : US
Telephone Number : 920-496-4700
Fax Number :
Provider Business Practice Location Address
First Line : 1715 DOUSMAN ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54303-3211
Country : US
Telephone Number : 920-272-1570
Fax Number : 920-431-1823
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2005
Last Update Date : 09/15/2016

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