Provider Demographics
NPI:1235173121
Name:RIESS-SAGERS, KIM R (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:R
Last Name:RIESS-SAGERS
Suffix:
Gender:F
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:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-433-7864
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:300 N COMMERCIAL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2619
Practice Address - Country:US
Practice Address - Phone:920-886-0818
Practice Address - Fax:920-886-0773
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32361207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21280500Medicaid
WI31720300Medicaid
WI000740220Medicare ID - Type Unspecified
WI21280500Medicaid