Al Baltrusaitis, D.O.
Individual provider Active NPI Preventive Medicine/Occupational Environmental Medicine Physician · Green Bay, WI
NPI 1699747105 · NPPES record last updated Apr 5, 2010
Key facts
- NPI
- 1699747105
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Preventive Medicine/Occupational Environmental Medicine Physician 2083P0500X
- License
- 24456 (WI)
- Practice address
- 3021 Voyager Dr
Green Bay, WI 54311-8303 - Phone
- (920) 496-4700
- NPI assigned
- Feb 7, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040623000425 | WI | Practitioner - Preventive Medicine | 6406831486 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24456 | WI | MD | Preventive Medicine/Occupational Environmental Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ascension Medical Group-Southeast Wisconsin Inc | Current |
Accepting new patients | |
| Prohealth Medical Group Inc. | Past |
Accepting new patients |
Locations
13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400
400 W River Woods Pkwy
Fl 3
Glendale, WI 53212
Phone (414) 465-3091
201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Preventive Medicine/Occupational Environmental Medicine Physician | 2083P0500X | 24456 | WI | Yes |
Addresses
Primary practice location
3021 Voyager Dr
Green Bay, WI 54311-8303
Mailing address
3021 Voyager Dr
Green Bay, WI 54311-8303
Phone (920) 496-4700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30018600 | Medicaid | WI |
Other providers in Green Bay, WI
- Jill Ball
- Elisabeth V Ballard
- Bela R. Ballo
- Frances Stahl Ballo
- Jennifer Lynn Balthazor
- James Joseph Balza
- Kyla S Balzar
- Denise M Balzola
- Stephanie Banaszynski
- Lauren Louise Bancroft
All providers in Green Bay, WI · Preventive Medicine/Occupational Environmental Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 5, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.