NPI 1104854462

Ahmet Dervish, MD

Practitioner Interventional Pain Medicine Physician Green Bay, WI

Practice location

Address: 2845 Greenbrier Rd STE 340, Green Bay, WI 54311-6519
Phone: (920) 288-8380
Fax: (920) 288-8385
Mailing address: 2845 Greenbrier Rd STE 340 PO Box 8900, Green Bay, WI 54308-8900

Registered specialties

Interventional Pain Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208VP0014X Licence 33794 (WI)

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Registry record

NPI: 1104854462
Entity type: Individual
Sex (as registered): Male
NPI issued: 28 Jun 2006
Record last updated: 29 Aug 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.