Mark Kurt Villwock, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25474 Issued in WI

Practice address

3021 Voyager Dr
Green Bay, WI 54311-8303

Phone

(920) 496-4700

Fax

(920) 272-1573

NPI assigned

Jul 18, 2006

Last updated

Jul 22, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Prevea Regional Services, Inc.

  dba Prevea Regional

  • Family Medicine Physician
  • Green Bay, WI
  • NPI 1194748061
  NPD (past)

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216684800000",
    "number": "1508885195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19070",
            "address_2": "PREVEA HEALTH",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543079070",
            "telephone_number": "920-496-4700",
            "fax_number": "920-272-1573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3021 VOYAGER DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543118303",
            "telephone_number": "920-496-4700",
            "fax_number": "920-272-1573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLWOCK",
        "first_name": "MARK",
        "middle_name": "KURT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2008-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "25474",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30575900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Village of Allouez (Village of Allouez - Fire Dept.)
• Village of Ashwaubenon (Ashwaubenon Public Safety)
• Village of Howard (Howard Fire Rescue)
• Manuel Urbano Villarreal
• Benjamin Mark Villwock, APNP
• Robert Melvin Villwock, DDS
• Kathryn Elizabeth Vils, PA-C
• Renae Vincent
• Tanya Ann Vincent
• Kyra Vinz

• Family Medicine Physician in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.