Provider Demographics
NPI:1487769584
Name:GREENLAW, PAUL N (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:N
Last Name:GREENLAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7226
Mailing Address - Fax:920-445-7229
Practice Address - Street 1:311 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-2401
Practice Address - Country:US
Practice Address - Phone:920-743-0255
Practice Address - Fax:920-743-6680
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2020-04-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI49635-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34898500Medicaid
WI34898500Medicaid