Individual
PHILIP J MITTELSTAEDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
845 PARKSIDE ST, RIPON, WI 54971-8505
(920) 748-3101
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
(920) 926-8370
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
77170-030
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43303800
—
WI
Enumeration date
10/05/2005
Last updated
10/21/2020
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