NPIMap

Organization Active NPI

Froedtert Manitowoc Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Manitowoc, WI
National Provider Identifier
1437829975
Registry record updated Jul 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
FROEDTERT MANITOWOC MEDICAL GROUP, LLC
Practice address
2300 Western Ave
Manitowoc, WI 54220-3712
Phone
(920) 320-2436
NPI assigned
Sep 16, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael W Degere, DPM
Title
Secretary/Treasurer
Phone
(920) 320-2095

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

2300 Western Ave
Manitowoc, WI 54220-3712

Mailing address

400 Woodland Prime Ste 103
N74 W12501 Leatherwood Court
Menomonee Falls, WI 53051-4490

Other practice location 1

1414 N Taylor Dr
Sheboygan, WI 53081-1988
Phone (920) 320-2011

Other practice location 2

2631 Eastern Ave
Plymouth, WI 53073-4270
Phone (920) 320-2436

Other practice location 3

800 Lakefront Way
Two Rivers, WI 54241-3301
Phone (920) 320-2011

Other practice location 4

4303 Michigan Ave
Manitowoc, WI 54220-3066
Phone (920) 320-2011

Other practice location 5

1650 S 41st St
Manitowoc, WI 54220-7316
Phone (920) 320-2011

Other practice location 6

1635 S 21st St
Manitowoc, WI 54220-6380
Phone (920) 320-2011

Other practice location 7

339 Reed Ave
Manitowoc, WI 54220-2020
Phone (920) 320-2011

Other practice location 8

1081 E Johnson St
Fond Du Lac, WI 54935-8919
Phone (920) 367-6700

Other practice location 9

3736 S Taylor Dr
Sheboygan, WI 53081-8432
Phone (920) 476-6300

Other names 1

  • Froedtert Northeast Medical Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220224001282 WI Part B Supplier - Clinic/Group Practice 2365836954 Receives reassigned benefits from 364 practitioners
Practice locations: Fond Du Lac, WI; Two Rivers, WI; Sheboygan, WI; Plymouth, WI; Manitowoc, WI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D0958116Froedtert Manitowoc Medical Group, LLC2300 Western Avenue, Manitowoc, WI 54220Certificate of waiverAug 30, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

889 E Johnson St
Fond du Lac, WI 54935
Phone (920) 367-6700

3736 S Taylor Dr
Sheboygan, WI 53081
Phone (920) 476-6300

Practitioners & affiliated clinicians

Practitioners 389

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 389

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751846400000",
    "number": "1437829975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 WOODLAND PRIME STE 103",
            "address_2": "N74 W12501 LEATHERWOOD COURT",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "530514490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 WESTERN AVE",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542203712",
            "telephone_number": "920-320-2436"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1414 N Taylor Dr",
            "address_purpose": "LOCATION",
            "city": "Sheboygan",
            "state": "WI",
            "postal_code": "530811988",
            "country_code": "US",
            "telephone_number": "920-320-2011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2631 Eastern Ave",
            "address_purpose": "LOCATION",
            "city": "Plymouth",
            "state": "WI",
            "postal_code": "530734270",
            "country_code": "US",
            "telephone_number": "920-320-2436",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "800 Lakefront Way",
            "address_purpose": "LOCATION",
            "city": "Two Rivers",
            "state": "WI",
            "postal_code": "542413301",
            "country_code": "US",
            "telephone_number": "920-320-2011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4303 Michigan Ave",
            "address_purpose": "LOCATION",
            "city": "Manitowoc",
            "state": "WI",
            "postal_code": "542203066",
            "country_code": "US",
            "telephone_number": "920-320-2011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1650 S 41st St",
            "address_purpose": "LOCATION",
            "city": "Manitowoc",
            "state": "WI",
            "postal_code": "542207316",
            "country_code": "US",
            "telephone_number": "920-320-2011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1635 S 21st St",
            "address_purpose": "LOCATION",
            "city": "Manitowoc",
            "state": "WI",
            "postal_code": "542206380",
            "country_code": "US",
            "telephone_number": "920-320-2011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "339 Reed Ave",
            "address_purpose": "LOCATION",
            "city": "Manitowoc",
            "state": "WI",
            "postal_code": "542202020",
            "country_code": "US",
            "telephone_number": "920-320-2011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1081 E Johnson St",
            "address_purpose": "LOCATION",
            "city": "Fond Du Lac",
            "state": "WI",
            "postal_code": "549358919",
            "country_code": "US",
            "telephone_number": "920-367-6700",
            "fax_number": "262-799-4657",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3736 S Taylor Dr",
            "address_purpose": "LOCATION",
            "city": "Sheboygan",
            "state": "WI",
            "postal_code": "530818432",
            "country_code": "US",
            "telephone_number": "920-476-6300",
            "fax_number": "920-328-1403",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FROEDTERT MANITOWOC MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-16",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "status": "A",
        "authorized_official_last_name": "DEGERE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "SECRETARY/TREASURER",
        "authorized_official_telephone_number": "920-320-2095",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Froedtert Northeast Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manitowoc, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.