Basic Information
| Provider Information | |||||||||
| NPI: | 1679667554 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEUMANN | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2290 | ||||||||
| Address2: | |||||||||
| City: | MANITOWOC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 542212290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203202591 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 HEALTHY WAY | ||||||||
| Address2: | |||||||||
| City: | OLIVIA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3205231261 | ||||||||
| FaxNumber: | 3205238493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 05/29/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 313 | MN | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 390806395294 | 01 | WI | BLUE CROSS BLUE SHIELD | OTHER | 43240400 | 05 | WI | MEDICAID |