Provider Demographics
NPI:1235141334
Name:PRIEBE, DANIEL D (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:D
Last Name:PRIEBE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 HUMMINGBIRD RD
Mailing Address - Street 2:STE 100
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-6312
Mailing Address - Country:US
Mailing Address - Phone:715-359-6442
Mailing Address - Fax:715-393-0390
Practice Address - Street 1:5200 HUMMINGBIRD RD
Practice Address - Street 2:STE 100
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-6312
Practice Address - Country:US
Practice Address - Phone:715-359-6442
Practice Address - Fax:715-393-0390
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42766207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30098400Medicaid
WI30098400Medicaid
WIF01945Medicare UPIN
WI347570Medicare ID - Type Unspecified
WIBP2312914OtherDEA #