Provider Demographics
NPI:1447325691
Name:FROEDTERT HOLY FAMILY HOSPITAL
Entity type:Organization
Organization Name:FROEDTERT HOLY FAMILY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:STRADL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-320-3000
Mailing Address - Street 1:2300 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-3712
Mailing Address - Country:US
Mailing Address - Phone:920-320-3000
Mailing Address - Fax:920-458-9882
Practice Address - Street 1:2631 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073-4270
Practice Address - Country:US
Practice Address - Phone:920-476-6350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21290500Medicaid
WI31915100Medicaid
WI30521400Medicaid
WIC50929Medicare UPIN
WID95720Medicare UPIN
WI30521400Medicaid