Provider Demographics
NPI:1023243805
Name:TUTTLE, PAUL VERNON IV (DO)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:VERNON
Last Name:TUTTLE
Suffix:IV
Gender:
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2223 LIME KILN RD
Mailing Address - Street 2:STE 1
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-6213
Mailing Address - Country:US
Mailing Address - Phone:920-430-8120
Mailing Address - Fax:920-430-8122
Practice Address - Street 1:2223 LIME KILN RD
Practice Address - Street 2:STE 1
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6213
Practice Address - Country:US
Practice Address - Phone:920-430-8120
Practice Address - Fax:920-430-8122
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
WI64162-21207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program