Provider Demographics
NPI:1962487165
Name:RINGWELSKI, MARK BRIAN (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:BRIAN
Last Name:RINGWELSKI
Suffix:
Gender:M
Credentials:DO
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:920-445-7222
Mailing Address - Fax:920-445-7229
Practice Address - Street 1:3263 EATON ROAD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-8046
Practice Address - Country:US
Practice Address - Phone:920-430-4560
Practice Address - Fax:920-430-4558
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43862207Q00000X
WI43862-212083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIF07672Medicare UPIN
WIK400222825Medicare Oscar/Certification