Provider Demographics
NPI:1710989090
Name:RIEDER, ANTHONY A (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:A
Last Name:RIEDER
Suffix:
Gender:M
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 26071
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-0071
Mailing Address - Country:US
Mailing Address - Phone:414-727-0910
Mailing Address - Fax:414-727-9020
Practice Address - Street 1:2727 N MAYFAIR RD STE I
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-4400
Practice Address - Country:US
Practice Address - Phone:414-727-0910
Practice Address - Fax:414-727-9020
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIME43631207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34615200Medicaid
WI34615200Medicaid