Niedfeldt, Mark W
Niedfeldt, Mark W is an individual health care provider with primary practice located at 10556 North Port Washington Road Suite 101, Mequon WI 53092-5586. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Niedfeldt, Mark W can be contacted via phone (262) 643-4720.Contact Information
Primary practice address
10556 North Port Washington Road Suite 101
Mequon WI 53092-5586
Phone: (262) 643-4720
Fax: (262) 643-4721
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 35201 | Wisconsin |
Profile Details
| NPI number | 1205887775 |
|---|---|
| LBN Legal business name | Niedfeldt, Mark W |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 12th, 2006 |
| Last updated | Nov 3rd, 2008 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1205887775 | NPPES |
| Other | 002000187C | HUMANA | |
| MEDICAID | 32113600 | HUMANA |
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