Provider Demographics
NPI:1043295256
Name:SONCRANT, GEORGE D (DO)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:D
Last Name:SONCRANT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3000 RIVERSIDE DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-1653
Mailing Address - Country:US
Mailing Address - Phone:920-632-7040
Mailing Address - Fax:920-632-7262
Practice Address - Street 1:3000 RIVERSIDE DR
Practice Address - Street 2:SUITE 180
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-1653
Practice Address - Country:US
Practice Address - Phone:920-632-7040
Practice Address - Fax:920-632-7262
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI387892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32369900Medicaid
WI32369900Medicaid
WI000307860Medicare PIN