Organization
PREMIER SURGICAL OF WISCONSIN SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIMBERLY A RIDL MD (PRESIDENT)
(920) 686-7900
Entity
Organization
Contact information
Practice address
940 MARITIME DR, STE 4, MAINTOWOC, WI 54220-2960
(920) 686-7900
(920) 686-7984
Mailing address
940 MARITIME DR, STE 4, MANITOWOC, WI 54220-2960
(920) 686-7900
(920) 686-7984
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
19677020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31123900
—
WI
01
—
DG9827
RAILROAD MEDICARE
WI
Enumeration date
09/20/2006
Last updated
08/08/2023
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