Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 13589-20 | WI |
NPI | 1184155194 |
---|---|
Provider Name | Dr. Richard Edgar Rieselbach |
First Address | Middleton, WI 53562 |
Second Address | Middleton, WI 53562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2017 |
Last Update Date | 22/03/2017 |