Provider Demographics
NPI:1669400883
Name:GRIESSER, ROBERT C (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:GRIESSER
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 1:7868 BEDROCK FLATS LN E
Mailing Address - Street 2:
Mailing Address - City:BAILEYS HARBOR
Mailing Address - State:WI
Mailing Address - Zip Code:54202
Mailing Address - Country:US
Mailing Address - Phone:920-217-9704
Mailing Address - Fax:
Practice Address - Street 1:2845 GREENBRIER RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6519
Practice Address - Country:US
Practice Address - Phone:920-288-3388
Practice Address - Fax:920-288-3370
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26659207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104082944Medicaid
WI050064020OtherRAILROAD
MI104390521Medicaid
WI30654000Medicaid
WIB53246Medicare UPIN
WI30654000Medicaid