| Colab Physicians, Sc | |
|
10325 N Port Washington Rd Ste 150 Mequon WI 53092-5768 | |
| (262) 643-4720 | |
| (262) 643-4720 |
| Full Name | Colab Physicians, Sc |
|---|---|
| Speciality | Family Medicine |
| Location | 10325 N Port Washington Rd Ste 150, Mequon, Wisconsin |
| Authorized Official Name and Position | Mark W Niedfeldt (PRESIDENT) |
| Authorized Official Contact | 2626434720 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Colab Physicians, Sc 6400 Industrial Loop Greendale WI 53129-2452 Ph: (414) 858-4106 | Colab Physicians, Sc 10325 N Port Washington Rd Ste 150 Mequon WI 53092-5768 Ph: (262) 643-4720 |
| NPI Number | 1902666035 |
|---|---|
| Provider Enumeration Date | 03/19/2024 |
| Last Update Date | 03/19/2024 |
| Medicare PECOS PAC ID | 1052853561 |
|---|---|
| Medicare Enrollment ID | O20240611003317 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902666035 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Mark Niedfeldt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205887775 PECOS PAC ID: 7618941113 Enrollment ID: I20040820000961 |
| Provider Name | Jessica E Furey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811334501 PECOS PAC ID: 5890004030 Enrollment ID: I20161025000376 |
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