Bongiorno, Edward J

Bongiorno, Edward J is an individual health care provider with primary practice located at 1630 Commanche Ave , Green Bay WI 54313-5753. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Bongiorno, Edward J can be contacted via phone (920) 430-4700.

Contact Information

Primary practice address
1630 Commanche Ave Green Bay WI 54313-5753
Phone: (920) 430-4700
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 4508 Wisconsin
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 45808 Wisconsin
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 45808 Wisconsin

Profile Details

NPI number 1992789754
LBN Legal business name Bongiorno, Edward J
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 5th, 2005
Last updated Feb 27th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1992789754 NPPES
Wisconsin MEDICAID 43507600

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