Basic Information
| Provider Information | |||||||||
| NPI: | 1407348345 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIANCHETTA | ||||||||
| FirstName: | CODY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 78866 | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532788866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7796967150 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5665 N JUNCTION WAY | ||||||||
| Address2: | |||||||||
| City: | DAVIS JUNCTION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610209433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7976969200 | ||||||||
| FaxNumber: | 8156451408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2018 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036.157630 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.