Provider Demographics
NPI:1023034832
Name:KIEFER, PATRICK JAMES (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:JAMES
Last Name:KIEFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 OAK RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-9267
Mailing Address - Country:US
Mailing Address - Phone:920-336-1662
Mailing Address - Fax:920-336-5745
Practice Address - Street 1:4500 OAK RIDGE CIR
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-9267
Practice Address - Country:US
Practice Address - Phone:920-336-1662
Practice Address - Fax:920-336-5745
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI280082086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30745300Medicaid
B54121Medicare UPIN
WI30745300Medicaid