Provider Demographics
NPI:1982658365
Name:RIETER PODIATRY ASSOCIATES SC
Entity Type:Organization
Organization Name:RIETER PODIATRY ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:RIETER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:262-338-0901
Mailing Address - Street 1:626 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-3255
Mailing Address - Country:US
Mailing Address - Phone:262-338-0901
Mailing Address - Fax:262-338-9977
Practice Address - Street 1:626 CEDAR ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3255
Practice Address - Country:US
Practice Address - Phone:262-338-0901
Practice Address - Fax:262-338-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI669213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43268000Medicaid
WI=========0109OtherBLUE CROSS BLUE SHIELD
WI000083605Medicare PIN
WI=========0109OtherBLUE CROSS BLUE SHIELD
U32681Medicare UPIN