Individual
DR. MARK W NIEDFELDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10325 N PORT WASHINGTON RD STE 150, MEQUON, WI 53092-5768
(262) 643-4720
(262) 643-4721
Mailing address
10556 NORTH PORT WASHINGTON ROAD, 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
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002000187C
HUMANA
—
05
—
32113600
—
WI
Enumeration date
05/12/2006
Last updated
09/24/2024
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