Provider Demographics
NPI:1225013675
Name:WOZNEY, BRADLEY B (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:B
Last Name:WOZNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:595 COUNTY RD R
Practice Address - Street 2:
Practice Address - City:DENMARK
Practice Address - State:WI
Practice Address - Zip Code:54208
Practice Address - Country:US
Practice Address - Phone:920-863-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38200OtherLICENSE
MI4301090202OtherMI LICENSE
WI007100215Medicare Oscar/Certification
WIG36737Medicare UPIN
WI000907290Medicare Oscar/Certification
WI073100013Medicare Oscar/Certification
WI401600074Medicare Oscar/Certification
WI38200OtherLICENSE
WI000940018Medicare Oscar/Certification
WI000008Medicare Oscar/Certification
WI000009Medicare Oscar/Certification
MI4301090202OtherMI LICENSE
WI000010Medicare Oscar/Certification
WI000013Medicare Oscar/Certification