Provider Demographics
NPI:1952729774
Name:SPOHN, GINA PIETRAS (MD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:PIETRAS
Last Name:SPOHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:2806 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-6717
Practice Address - Country:US
Practice Address - Phone:920-498-7546
Practice Address - Fax:920-569-4129
Is Sole Proprietor?:No
Enumeration Date:2014-03-29
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME136386207N00000X
WI83317-20207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100523700Medicaid
FLME136386OtherMEDICAL LICENSE