Provider Demographics
NPI:1629442181
Name:DYSPHAGIA TESTING, LLC
Entity Type:Organization
Organization Name:DYSPHAGIA TESTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:RIEGG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-442-2152
Mailing Address - Street 1:10638 HIDDEN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-8538
Mailing Address - Country:US
Mailing Address - Phone:262-442-2152
Mailing Address - Fax:
Practice Address - Street 1:10638 HIDDEN CREEK DR
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-8538
Practice Address - Country:US
Practice Address - Phone:262-442-2152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33675-202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty