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NPI Code Detail

MEDICARE: EDWARD J BONGIORNO DO

MEDICARE: EDWARD J BONGIORNO DO
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
1207R00000XInternal Medicine Physician4508WI
2208000000XPediatrics Physician45808WI
3207Q00000XFamily Medicine Physician45808WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1992789754
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD J BONGIORNO DO
Provider Business Mailing Address
First Line : 1630 COMMANCHE AVE
Second Line :
City : GREEN BAY
State : WI
Zip : 54313-5753
Country : US
Telephone Number : 920-430-4700
Fax Number :
Provider Business Practice Location Address
First Line : 1630 COMMANCHE AVE
Second Line :
City : GREEN BAY
State : WI
Zip : 54313-5753
Country : US
Telephone Number : 920-430-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2005
Last Update Date : 02/27/2014

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