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NPI Code Detail

MEDICARE: GINA PIETRAS SPOHN MD

MEDICARE: GINA PIETRAS SPOHN 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
1207N00000XDermatology Physician83317-20WI

General Provider Information

NPI Number : 1952729774
Entity Type Code : Individual
Provider Name (Legal Business Name) : GINA PIETRAS SPOHN MD
Provider Business Mailing Address
First Line : 801 YORK ST
Second Line :
City : MANITOWOC
State : WI
Zip : 54220-4630
Country : US
Telephone Number : 920-663-9008
Fax Number : 920-684-1439
Provider Business Practice Location Address
First Line : 2806 RIVERVIEW DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54313-6717
Country : US
Telephone Number : 920-498-7546
Fax Number : 920-569-4129
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2014
Last Update Date : 10/29/2024

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