Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 20844 | WI |
NPI | 1316012024 |
---|---|
Provider Name | Dr. Gregory M Nierengarten |
First Address | Greenfield, WI 53221-2515 |
Second Address | Milwaukee, WI 53215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30013700 | (05) | WI |
B55375 | (02) |