| East Side Family Practice Sc | |
|
424 S Monroe Ave Ste 106 Green Bay WI 54301-4054 | |
| (920) 437-4366 | |
| (920) 437-0954 |
| Full Name | East Side Family Practice Sc |
|---|---|
| Speciality | Family Medicine |
| Location | 424 S Monroe Ave Ste 106, Green Bay, Wisconsin |
| Authorized Official Name and Position | Joseph Robert Dobson (PRESIDENT) |
| Authorized Official Contact | 9204374366 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| East Side Family Practice Sc 424 S Monroe Ave Ste 106 Green Bay WI 54301-4054 Ph: (920) 437-4366 | East Side Family Practice Sc 424 S Monroe Ave Ste 106 Green Bay WI 54301-4054 Ph: (920) 437-4366 |
| NPI Number | 1861527863 |
|---|---|
| Provider Enumeration Date | 02/22/2007 |
| Last Update Date | 10/25/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861527863 | NPI | - | NPPES |
| 80085001 | Other | RR MEDICARE PROV # | |
| 30021900 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 26550 (Wisconsin) | Primary |
| 208D00000X | General Practice | 26550 (Wisconsin) | Secondary |
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