Mark W Niedfeldt, MD, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35201 Issued in WI

Legal business name

MARK W NIEDFELDT, MD, LLC

Practice address

10556 N Port Washington Rd
Ste 101
Mequon, WI 53092-5586

Phone

(262) 643-4720

Fax

(262) 643-4721

NPI assigned

Mar 6, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark W Niedfeldt, M.D.NPI 1205887775

Title

Owner

Phone

(262) 643-4720

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark W Niedfeldt, MD

  • Family Medicine Physician
  • Mequon, WI
  • NPI 1205887775
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1236297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236297600000",
    "number": "1174764906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10556 N PORT WASHINGTON RD",
            "address_2": "SUITE 101",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925586",
            "telephone_number": "262-643-4720",
            "fax_number": "262-643-4721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10556 N PORT WASHINGTON RD",
            "address_2": "STE 101",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925586",
            "telephone_number": "262-643-4720",
            "fax_number": "262-643-4721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK W NIEDFELDT, MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-06",
        "last_updated": "2009-03-06",
        "status": "A",
        "authorized_official_last_name": "NIEDFELDT",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-643-4720",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "35201",
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": "WI",
            "license": "35201",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul J Mankus, MD
• Chloe Mann
• Erika L Mantsch, PA-C
• Delan Joshua Manzo
• Irwin Margolis, M.D.
• Kayla Markle
• Douglas Richard Martin, D.D.S.
• Brian Shawn Martinezdelacotera, LPC
• Maryam K Doyle MD SC
• Michael Antonio Marzette Jr.

• Family Medicine Physician in Mequon, WI
• Providers in Mequon, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.