Provider Demographics
NPI:1215962675
Name:MONETTE, ROBERT J (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:MONETTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3006
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-0006
Mailing Address - Country:US
Mailing Address - Phone:920-499-1428
Mailing Address - Fax:920-499-7080
Practice Address - Street 1:1789 SHAWANO AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-3243
Practice Address - Country:US
Practice Address - Phone:920-499-1428
Practice Address - Fax:920-499-7080
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI304680202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4767196Medicaid
P00028704OtherRR MEDICARE
1018826005OtherUNITED HEALTHCARE AMERICH
WI31899700Medicaid
567565OtherDEAN HEALTH
14139OtherDEAN HEALTH
MI4724009Medicaid
300043284OtherRR MEDICARE
072730009Medicare ID - Type Unspecified
P00028704OtherRR MEDICARE
WI000007Medicare Oscar/Certification
300043284OtherRR MEDICARE
F49395Medicare UPIN