Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 66526 | WI |
NPI | 1073817268 |
---|---|
Provider Name | Dr. Shawn Allen Belverud |
First Address | Green Bay, WI 54301-3526 |
Second Address | Green Bay, WI 54301-3526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2011 |
Last Update Date | 02/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1073817268 | (05) | WI |