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Contact Information

SUBASH BASTAKOTI, MD
2845 GREENBRIER RD
GREEN BAY, WI54311-6519
 Phone: 920-288-8000
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Critical Care Medicine

207RC0200X 11 Physician/Internal Medicine
 

Internal Medicine

207R00000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for SUBASH BASTAKOTI · (Male)

NPI # 1770967036
Status Active
Credentials MD
Entity Individual
Enumeration date 07/16/2015
Last updated 11/22/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • MI License # 4301108025
  • WI License # 72088
  • WI Medicaid 100099224
Hospital affiliation(s)
  • AURORA BAYCARE MED CTR - (Acute Care)
    2845 GREENBRIER RD
    GREEN BAY, WI 54311
  • AURORA MED CTR MANITOWOC CTY - (Acute Care)
    5000 MEMORIAL DRIVE
    TWO RIVERS, WI 54241
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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