Provider Demographics
NPI:1154516078
Name:WISCONSIN VEIN INSTITUTE
Entity type:Organization
Organization Name:WISCONSIN VEIN INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:V
Authorized Official - Last Name:ROBELEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-884-8346
Mailing Address - Street 1:1841 S RIDGE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-3938
Mailing Address - Country:US
Mailing Address - Phone:920-884-8346
Mailing Address - Fax:
Practice Address - Street 1:1841 S RIDGE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-3938
Practice Address - Country:US
Practice Address - Phone:920-884-8346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43380020208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H29838Medicare UPIN