Provider Demographics
NPI:1598815599
Name:GRIESEL, JEAN CAREY (DO)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:CAREY
Last Name:GRIESEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:BOSCOBEL
Mailing Address - State:WI
Mailing Address - Zip Code:53805
Mailing Address - Country:US
Mailing Address - Phone:712-592-1327
Mailing Address - Fax:
Practice Address - Street 1:532 1ST ST NW
Practice Address - Street 2:
Practice Address - City:BRITT
Practice Address - State:IA
Practice Address - Zip Code:50423-2607
Practice Address - Country:US
Practice Address - Phone:641-843-5067
Practice Address - Fax:641-843-5001
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55094-021207Q00000X
IA02716207Q00000X
IL036.134738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI61146OtherDEAN HEALTH INSURANCE
WI100015684Medicaid
WI571550187Medicare PIN