Provider Demographics
NPI:1154438265
Name:UTRIE, JOHN W (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:UTRIE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2845 GREENBRIER RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54308-8900
Mailing Address - Country:US
Mailing Address - Phone:920-288-8510
Mailing Address - Fax:
Practice Address - Street 1:2845 GREENBRIER RD
Practice Address - Street 2:#450
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54308-8900
Practice Address - Country:US
Practice Address - Phone:920-288-8510
Practice Address - Fax:920-288-8511
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2021-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI29590207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31865600Medicaid
WI009707440Medicare PIN