Provider Demographics
NPI:1427235712
Name:BELLIN MEMORIAL HOSPITAL INC. DBA FMC MANITOWOC
Entity type:Organization
Organization Name:BELLIN MEMORIAL HOSPITAL INC. DBA FMC MANITOWOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KORDIYAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-482-9394
Mailing Address - Street 1:1765 N 18TH ST
Mailing Address - Street 2:PO BOX 520
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-1868
Mailing Address - Country:US
Mailing Address - Phone:920-482-9394
Mailing Address - Fax:920-482-0579
Practice Address - Street 1:1765 N 18TH ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-1868
Practice Address - Country:US
Practice Address - Phone:920-482-9394
Practice Address - Fax:920-482-0579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30743-020261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care