Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Edward John Bantamoi, MD

Individual provider Family Medicine Physician · NPI 1457376758

Edward John Bantamoi, MD is a Family Practice in Green Bay, Wisconsin. Qualified in 1996, 30 years ago. Practices with St Vincent Hospital-Hospital Sisters-Third Order of St Francis, a 594-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
30
Licensed in
WI
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

2502 S Ashland Ave
Green Bay, WI 54304
Phone: (920) 496-4700
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 48796 (WI)

Record details

NPI number1457376758
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJuly 13, 2006
Last updated in NPPESSeptember 18, 2017

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 1996 (30 years in practice)
Group practice St Vincent Hospital-Hospital Sisters-Third Order Of St Francis — 594 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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