Provider Demographics
NPI:1578839387
Name:GRIESBACH, SIMON B (MD)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:B
Last Name:GRIESBACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 NW BARSTOW ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3771
Mailing Address - Country:US
Mailing Address - Phone:262-548-6903
Mailing Address - Fax:262-548-3820
Practice Address - Street 1:210 NW BARSTOW ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3771
Practice Address - Country:US
Practice Address - Phone:262-548-6903
Practice Address - Fax:262-548-3820
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2015-06-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI61212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine