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Organization

MARK W NIEDFELDT, MD, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MARK W NIEDFELDT M.D. (OWNER)
(262) 643-4720
Entity
Organization

Contact information

Practice address
10556 N PORT WASHINGTON RD, STE 101, MEQUON, WI 53092-5586
(262) 643-4720
(262) 643-4721
Mailing address
10556 N PORT WASHINGTON RD, SUITE 101, MEQUON, WI 53092-5586
(262) 643-4720
(262) 643-4721

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35201
WI
207QS0010X
Sports Medicine (Family Medicine) Physician
35201
WI

Other

Enumeration date
03/06/2009
Last updated
03/06/2009
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