Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 598 | WI |
NPI | 1154424489 |
---|---|
Provider Name | Dr. Gregory Todd Rifleman |
First Address | Prescott, WI 54021-7026 |
Second Address | Minneapolis, MN 55417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 08/07/2007 |