Provider Demographics
NPI:1295790749
Name:KRIEGER, WESTSCOT G (MD)
Entity type:Individual
Prefix:DR
First Name:WESTSCOT
Middle Name:G
Last Name:KRIEGER
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 1:1611 E ROBIN WAY
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-4214
Mailing Address - Country:US
Mailing Address - Phone:920-428-6080
Mailing Address - Fax:920-815-3164
Practice Address - Street 1:1125 WITTMANN DR
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-3607
Practice Address - Country:US
Practice Address - Phone:920-428-6080
Practice Address - Fax:920-815-3164
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26410174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
B54330Medicare UPIN
WI005000240Medicare ID - Type Unspecified