| Dba Clinica Hispana | |
|
704 S Webster Ave Ste 201 Green Bay WI 54301-3528 | |
| (920) 433-3410 | |
| (920) 433-3419 |
| Full Name | Dba Clinica Hispana |
|---|---|
| Speciality | Family Medicine |
| Location | 704 S Webster Ave Ste 201, Green Bay, Wisconsin |
| Authorized Official Name and Position | Denise K Stroobants (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 9204457222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dba Clinica Hispana Po Box 22487 Green Bay WI 54305-2487 Ph: (920) 445-7222 | Dba Clinica Hispana 704 S Webster Ave Ste 201 Green Bay WI 54301-3528 Ph: (920) 433-3410 |
| NPI Number | 1104022128 |
|---|---|
| Provider Enumeration Date | 06/26/2007 |
| Last Update Date | 04/06/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104022128 | NPI | - | NPPES |
| 21312700 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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