Provider Demographics
NPI:1689850349
Name:MARIENFELD, KATHERINE ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELLEN
Last Name:MARIENFELD
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:W 3275 WOLF RIVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:KESHENA
Mailing Address - State:WI
Mailing Address - Zip Code:54135
Mailing Address - Country:US
Mailing Address - Phone:715-799-3361
Mailing Address - Fax:
Practice Address - Street 1:W 3275 WOLF RIVER DRIVE
Practice Address - Street 2:
Practice Address - City:KESHENA
Practice Address - State:WI
Practice Address - Zip Code:54135
Practice Address - Country:US
Practice Address - Phone:715-799-3361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51922-020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI12081850Medicare UPIN