Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 546-025 | WI |
Y | 222Z00000X | Podiatrist | 546-025 | WI |
NPI | 1053304295 |
---|---|
Provider Name | Dr. Edward Patrick Vanbeek |
First Address | Green Bay, WI 54311-5645 |
Second Address | Green Bay, WI 54311-5645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 09/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0444780001 | MEDICARE DME (01) | |
480004056 | RAILROAD MEDICARE (01) | |
T-63560 | (02) |