Provider Demographics
NPI:1821011800
Name:GUELDNER, TERRY (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:GUELDNER
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 1:940 MARITIME DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-2960
Mailing Address - Country:US
Mailing Address - Phone:920-686-7900
Mailing Address - Fax:
Practice Address - Street 1:940 MARITIME DR
Practice Address - Street 2:SUITE 4
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2960
Practice Address - Country:US
Practice Address - Phone:920-686-7900
Practice Address - Fax:920-686-7985
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19677020208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31123900Medicaid
WI31123900Medicaid