Provider Demographics
NPI:1962622522
Name:THE CARING DOCTOR, LLC
Entity type:Organization
Organization Name:THE CARING DOCTOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GENADI
Authorized Official - Middle Name:
Authorized Official - Last Name:MALTINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-855-2823
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:KRAKOW
Mailing Address - State:WI
Mailing Address - Zip Code:54137-0134
Mailing Address - Country:US
Mailing Address - Phone:920-855-2823
Mailing Address - Fax:920-855-6343
Practice Address - Street 1:340 N GREEN BAY AVE
Practice Address - Street 2:
Practice Address - City:GILLETT
Practice Address - State:WI
Practice Address - Zip Code:54124-9325
Practice Address - Country:US
Practice Address - Phone:920-855-2823
Practice Address - Fax:920-855-6343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38713-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32368600Medicaid
WI1710966288OtherGENADI MALTINSKI
WI000043090Medicare ID - Type UnspecifiedGENADI MALTINSKI
WI32368600Medicaid