| Mark W Niedfeldt, Md, Llc | |
|
10556 N Port Washington Rd Ste 101 Mequon WI 53092-5586 | |
| (262) 643-4720 | |
| (262) 643-4721 |
| Full Name | Mark W Niedfeldt, Md, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 10556 N Port Washington Rd, Mequon, Wisconsin |
| Authorized Official Name and Position | Mark W Niedfeldt (OWNER) |
| Authorized Official Contact | 2626434720 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark W Niedfeldt, Md, Llc 10556 N Port Washington Rd Suite 101 Mequon WI 53092-5586 Ph: (262) 643-4720 | Mark W Niedfeldt, Md, Llc 10556 N Port Washington Rd Ste 101 Mequon WI 53092-5586 Ph: (262) 643-4720 |
| NPI Number | 1174764906 |
|---|---|
| Provider Enumeration Date | 03/06/2009 |
| Last Update Date | 03/06/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174764906 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 35201 (Wisconsin) | Primary |
| 207QS0010X | Family Medicine - Sports Medicine | 35201 (Wisconsin) | Secondary |
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