Robert Liedtke, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

38057 Issued in WI

Practice address

N82W23422 Five Iron Way
Sussex, WI 53089-1556

Phone

(414) 335-6921

NPI assigned

Feb 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• St. Croix Hospice, LLC

  • Community Based Hospice Care Agency
  • Baraboo, WI
  • NPI 1649589540

  Contracted Managing Employee, Operational/Managerial Control

  CMS ownership

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

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685577600000",
    "number": "1780657353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N82W23422 FIVE IRON WAY",
            "city": "SUSSEX",
            "state": "WI",
            "postal_code": "530891556",
            "telephone_number": "414-335-6921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N82W23422 FIVE IRON WAY",
            "city": "SUSSEX",
            "state": "WI",
            "postal_code": "530891556",
            "telephone_number": "414-335-6921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEDTKE",
        "first_name": "ROBERT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-13",
        "last_updated": "2023-06-01",
        "certification_date": "2023-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "38057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32431700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven Richard Knobloch, PHARM D
• Mai Kue Krasucki, PSY.D
• Katie E Krogmeier, PHARMD
• Kurt a Simons, DC, SC
• Julie N. Larsen, M.D.
• Lifespeed Physical Therapy and Fitness
• Jennifer N Lila, LCSW, CSAC
• Daniel Scott Loftus, DC
• Sharon Loftus, MT
• Patricia Mary Logan-Ott

• Family Medicine Physician in Sussex, WI
• Providers in Sussex, 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 Jun 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.