MEDICARE: DR. MARCELO U GRAZZIOTIN M.D.

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
1	174400000X	Specialist	46257	WI
2	208600000X	Surgery Physician	46257-20	WI

General Provider Information

NPI Number	:	1497758072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCELO U GRAZZIOTIN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 22487
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54305-2487
Country	:	US
Telephone Number	:	920-445-7210
Fax Number	:	920-445-7289

Provider Business Practice Location Address
First Line	:	720 S. VANBUREN ST. SUITE 201
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54301-3534
Country	:	US
Telephone Number	:	920-433-7488
Fax Number	:	920-438-7193

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/26/2022

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