Active NPI 1902911159 Individual Practitioner Male Practitioner

Dr. Alfredo Diaz , MD

Internal Medicine • Two Rivers, WI

Professional Overview & Biography Verified Profile Summary

Dr. Alfredo Diaz, MD is a certified Internal Medicine practicing in Two Rivers, WI. With approximately 31 years of clinical experience since graduating from University Of Nebraska College Of Medicine in 1995, Dr. Diaz delivers high-quality medical care to the local community at 2219 GARFIELD ST.

Dr. Diaz maintains professional affiliations with Aurora Medical Group, Inc., Aamg Reach Pllc and does not directly accept Medicare assignment.

Frequently performed procedures and clinical services include established patient outpatient office visit, anticoagulant management of patient taking warfarin, annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

2219 Garfield St

Two Rivers, WI 54241

Telephone 9207932281

Fax 9207947553

Associated Practice Facility / Clinic

🏢 Lakeshore Apothacare Inc Facility NPI 1821191974

Medicare Profile & Education

Medical School

University Of Nebraska College Of Medicine

Graduation Year

1995

Medicare Assignment

Not Specified

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Internal Medicine in Two Rivers, WI

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

31 Yrs +7.6 yrs vs City Avg

City Avg: 23.4 Yrs

State Avg: 26.2 Yrs

Regional Practice Density

9 Specialists

Practicing in Two Rivers, WI (2181 Statewide)

Telehealth Adoption Rate

22.2% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

71.5% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Diaz (31 Years) 31 Yrs

Two Rivers Specialty Average (23.4 Years) 23.4 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	677	384	$515.00	$113.61
93793 Anticoagulant management of patient taking warfarin	319	77	$85.00	$10.17
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	297	297	$360.00	$114.55
85610 Blood test, clotting time	259	55	$45.00	$4.20
G2211 Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's	151	134	$60.00	$14.61
G0008 Administration of influenza virus vaccine	114	111	$65.00	$30.42
90662 Influenza vaccine split virus, preservative free	105	102	$125.00	$79.32
99213 Established patient office or other outpatient visit, typically 15 minutes	100	88	$350.00	$79.32
90480 Admn sarscov2 vacc 1 dose	73	69	$90.00	$40.00
91322 Sarscov2 vac 50 mcg/0.5ml im	73	69	$250.00	$152.87
93000 Routine ekg using at least 12 leads including interpretation and report	62	61	$190.00	$12.21
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	32	15	$285.00	$95.33
99496 Transitional care management services for problem of high complexity	31	28	$1120.00	$241.28
90677 Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use	26	26	$488.46	$278.37
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	24	24	$530.00	$141.32
G0009 Administration of pneumococcal vaccine	24	24	$65.00	$30.42
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	23	23	$425.00	$147.34
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	21	19	$305.00	$47.68
93227 Electrocardiogram (ecg) 2-day continuous with review by health care professional	20	20	$245.00	$15.65
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	17	17	$755.00	$148.72
90656 Vaccine for influenza for administration into muscle, 0.5 ml dosage	11	11	$30.00	$21.90

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	682	395	$490.00	$115.77
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	338	338	$355.00	$117.76
G0008 Administration of influenza virus vaccine	136	133	$64.60	$28.93
99213 Established patient office or other outpatient visit, typically 15 minutes	127	110	$330.00	$81.91
90662 Influenza vaccine split virus, preservative free	126	123	$124.21	$71.66
93793 Anticoagulant management of patient taking warfarin	113	57	$80.00	$10.48
85610 Blood test, clotting time	101	30	$45.00	$4.20
93000 Routine ekg using at least 12 leads including interpretation and report	54	53	$190.00	$12.81
99496 Transitional care management services for problem of high complexity	39	33	$1070.00	$252.66
G0009 Administration of pneumococcal vaccine	36	36	$61.53	$28.93
90677 Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use	35	35	$475.00	$282.61
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	32	19	$280.00	$97.20
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	29	25	$305.00	$47.77
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	21	21	$420.00	$151.40
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	21	21	$520.00	$143.91
93227 Electrocardiogram (ecg) 2-day continuous with review by health care professional	20	20	$250.00	$16.98
69209 Removal of impacted ear wax by washing	17	17	$176.47	$17.15
G0403 Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report	13	13	$190.00	$13.03
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	12	12	$720.00	$150.88
90686 Vaccine for influenza for administration into muscle, 0.5 ml dosage	11	11	$30.00	$21.83

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	696	405	$465.00	$122.83
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	316	316	$355.00	$125.46
85610 Blood test, clotting time	171	17	$45.00	$4.23
G0008 Administration of influenza virus vaccine	161	157	$60.00	$28.00
90662 Influenza vaccine split virus, preservative free	154	150	$114.22	$67.84
99213 Established patient office or other outpatient visit, typically 15 minutes	133	118	$313.00	$87.22
93000 Routine ekg using at least 12 leads including interpretation and report	80	79	$195.00	$13.29
99496 Transitional care management services for problem of high complexity	54	50	$1020.00	$268.51
G0009 Administration of pneumococcal vaccine	37	37	$60.00	$28.14
90677 Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use	24	24	$460.42	$278.76
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	22	22	$520.00	$161.72
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	14	14	$420.00	$161.10
69209 Removal of impacted ear wax by washing	12	12	$191.67	$19.33
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	11	11	$206.36	$132.86

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	795	424	$435.00	$124.86
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	335	335	$350.00	$128.01
93793 Anticoagulant management of patient taking warfarin	180	48	$69.00	$11.08
G0008 Administration of influenza virus vaccine	131	131	$60.00	$16.22
99213 Established patient office or other outpatient visit, typically 15 minutes	124	107	$295.00	$87.71
90662 Influenza vaccine split virus, preservative free	121	121	$104.75	$64.61
99496 Transitional care management services for problem of high complexity	66	52	$970.00	$271.32
93000 Routine ekg using at least 12 leads including interpretation and report	52	50	$228.00	$14.19
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	33	33	$515.00	$164.03
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	32	16	$275.00	$87.74
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	28	28	$415.00	$164.36
G0009 Administration of pneumococcal vaccine	25	25	$60.00	$16.23
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	25	25	$198.20	$124.72
G0403 Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report	23	23	$228.00	$14.11
85610 Blood test, clotting time	21	11	$43.00	$4.29
69209 Removal of impacted ear wax by washing	16	16	$176.56	$18.44
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	12	12	$645.00	$137.19
90686 Vaccine for influenza for administration into muscle, 0.5 ml dosage	11	11	$25.00	$20.53

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
93793 Anticoagulant management of patient taking warfarin	755	145	$65.00	$11.17
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	710	423	$416.00	$104.90
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	328	328	$350.00	$112.16
G0008 Administration of influenza virus vaccine	168	165	$60.00	$16.24
90662 Influenza vaccine split virus, preservative free	158	155	$94.62	$60.36
99213 Established patient office or other outpatient visit, typically 15 minutes	139	121	$281.00	$72.28
85610 Blood test, clotting time	100	41	$43.00	$4.16
99496 Transitional care management services for problem of high complexity	62	55	$970.00	$231.21
93000 Routine ekg using at least 12 leads including interpretation and report	59	59	$224.00	$16.42
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	57	33	$265.00	$87.87
G0009 Administration of pneumococcal vaccine	51	50	$60.00	$15.84
99442 Telephone medical discussion with physician, 11-20 minutes	44	44	$240.00	$71.07
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	30	30	$515.00	$167.80
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	29	29	$192.24	$119.37
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	28	28	$415.00	$163.48
90670 Pneumococcal vaccine for injection into muscle	22	22	$369.55	$208.87
G0403 Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report	21	21	$235.00	$16.35
69209 Removal of impacted ear wax by washing	20	18	$165.85	$17.38
93227 Electrocardiogram (ecg) 2-day continuous with review by health care professional	11	11	$393.00	$26.37

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
93793 Anticoagulant management of patient taking warfarin	894	130	$62.00	$11.72
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	781	399	$393.00	$105.17
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	339	339	$350.00	$112.40
G0008 Administration of influenza virus vaccine	173	171	$59.83	$15.92
99213 Established patient office or other outpatient visit, typically 15 minutes	153	114	$265.00	$71.98
85610 Blood test, clotting time	151	49	$43.00	$4.18
90662 Influenza vaccine split virus, preservative free	143	141	$85.21	$54.78
93000 Routine ekg using at least 12 leads including interpretation and report	57	54	$215.00	$16.28
99496 Transitional care management services for problem of high complexity	54	50	$942.00	$224.93
G0009 Administration of pneumococcal vaccine	50	50	$56.90	$15.92
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	46	18	$263.00	$88.87
90670 Pneumococcal vaccine for injection into muscle	27	27	$367.96	$202.46
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	26	26	$188.46	$102.10
94729 Test to examine how well the lungs exchange gases	25	25	$99.00	$9.03
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	25	25	$414.00	$161.96
94726 Determination of lung volumes using plethysmography	24	24	$153.00	$12.23
94060 Test to measure expiratory airflow and volume changes before and after medication administration	24	24	$185.00	$12.94
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	22	22	$515.00	$159.32
90688 Vaccine for influenza for administration into muscle, 0.5 ml dosage	20	20	$25.00	$17.48
93018 Exercise or drug-induced heart stress test with electrocardiogram (ecg) with review by physician	20	20	$227.00	$14.71
93016 Exercise or drug-induced heart stress test with electrocardiogram (ecg) with supervision by physician	20	20	$234.00	$21.97
G0403 Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report	17	17	$231.00	$16.37
69209 Removal of impacted ear wax by washing	16	16	$145.19	$16.53
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	13	13	$582.00	$158.66
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	13	13	$577.15	$137.78

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	846	424	$374.00	$102.64
93793 Anticoagulant management of patient taking warfarin	409	114	$58.00	$11.51
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	350	350	$340.00	$110.92
85610 Blood test, clotting time	303	74	$43.00	$4.61
G0008 Administration of influenza virus vaccine	171	168	$54.59	$19.63
99213 Established patient office or other outpatient visit, typically 15 minutes	159	120	$252.00	$69.02
90662 Influenza vaccine split virus, preservative free	157	157	$89.75	$51.42
99496 Transitional care management services for problem of high complexity	62	52	$915.00	$207.49
93000 Routine ekg using at least 12 leads including interpretation and report	53	52	$209.00	$16.12
G0009 Administration of pneumococcal vaccine	47	47	$51.81	$19.63
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	46	14	$90.00	$19.74
J3420 Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg	44	13	$10.00	$1.97
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	38	38	$500.00	$160.34
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	36	12	$255.00	$87.94
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	31	31	$180.81	$105.59
93018 Exercise or drug-induced heart stress test with electrocardiogram (ecg) with review by physician	20	19	$227.00	$14.47
93016 Exercise or drug-induced heart stress test with electrocardiogram (ecg) with supervision by physician	20	19	$227.00	$21.61
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	19	18	$561.89	$113.33
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	18	18	$402.00	$142.06
90670 Pneumococcal vaccine for injection into muscle	18	18	$354.00	$187.13
90688 Vaccine for influenza for administration into muscle, 0.5 ml dosage	16	13	$30.00	$16.39
99220 Hospital observation care, typically 70 minutes	14	14	$619.00	$178.67

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	796	405	$356.00	$102.98
85610 Blood test, clotting time	413	70	$43.00	$5.17
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	387	79	$122.00	$18.92
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	343	343	$355.00	$110.53
99213 Established patient office or other outpatient visit, typically 15 minutes	205	163	$240.00	$69.83
G0008 Administration of influenza virus vaccine	156	152	$49.65	$24.29
90662 Influenza vaccine split virus, preservative free	140	140	$84.95	$47.66
G0009 Administration of pneumococcal vaccine	80	80	$46.56	$24.29
93000 Routine ekg using at least 12 leads including interpretation and report	62	61	$207.00	$15.98
J3420 Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg	53	11	$10.00	$3.08
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	48	13	$75.00	$24.42
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	44	44	$167.00	$93.90
90670 Pneumococcal vaccine for injection into muscle	37	37	$335.62	$184.80
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	36	36	$402.00	$159.16
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	33	21	$248.00	$87.88
99496 Transitional care management services for problem of high complexity	31	29	$889.00	$221.55
93016 Exercise or drug-induced heart stress test with electrocardiogram (ecg) with supervision by physician	29	29	$215.00	$21.63
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	29	29	$525.00	$163.87
93018 Exercise or drug-induced heart stress test with electrocardiogram (ecg) with review by physician	28	28	$227.00	$14.47
93227 Electrocardiogram (ecg) 2-day continuous with review by health care professional	20	20	$456.00	$26.13
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	19	19	$519.21	$138.45
G0403 Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report	13	13	$222.00	$16.27
36415 Insertion of needle into vein for collection of blood sample	13	11	$30.00	$2.71
99220 Hospital observation care, typically 70 minutes	12	12	$575.00	$178.88
90688 Vaccine for influenza for administration into muscle, 0.5 ml dosage	12	12	$31.25	$17.48
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	11	11	$528.00	$156.44
94729 Test to examine how well the lungs exchange gases	11	11	$95.00	$8.90
94060 Test to measure expiratory airflow and volume changes before and after medication administration	11	11	$179.00	$12.73

Medical Specialties & State Licenses

CMS Verified: 2021-12-01

Internal Medicine Primary Specialty

NUCC Taxonomy Code: 207R00000X

State License WI 39841

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Internal Medicine

NUCC Taxonomy Code: 207R00000X

State License NE 3310

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

32468200 (WI)

Hospital & Practice Group Affiliations

Aurora Medical Group, Inc.

5000 Memorial Dr, Two Rivers, WI 542413900

Phone: 9207945000

Aurora Medical Group, Inc.

5300 Memorial Dr, Two Rivers, WI 542413923

Phone: 9207937300

Aamg Reach Pllc

10400 75th St, Kenosha, WI 531427884

Phone: 2629487000

Aurora Medical Group, Inc.

1020 N 12th St, Milwaukee, WI 532331308

Phone: 4142193056

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

16 Associated Practitioners

Dr. Cedric Thayer , MD

Internal Medicine

NPI 1043327158

Doctor of Medicine (M.D.)

Dr. Janna Kroiss , DO

Family Medicine

NPI 1063831022

Doctor of Osteopathic Medicine (D.O.)

Dr. Ali Mir , MD

Pediatrics

NPI 1104934272

Doctor of Medicine (M.D.)

Madelyn Boney , NP

Nurse Practitioner

NPI 1144006560

Nurse Practitioner

Dr. Brian Laliberte , MD

Hospitalist

NPI 1205984531

Doctor of Medicine (M.D.)

Dr. Glenn Smith , MD

Family Medicine

NPI 1295842409

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

13 Historical Events

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) December 01, 2021

Internal Medicine (License #3310 in NE)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) May 29, 2020

Internal Medicine (License #39841 in WI)

✅

NPI Profile Active February 06, 2017

NPI status registered as active in NPPES database

📍

Updated Business Mailing Address February 06, 2017

Registered at 2219 GARFIELD ST, TWO RIVERS, WI 542412416 (Tel: 9207932281)

📍

Updated Practice Location February 06, 2017

Registered at 2219 GARFIELD ST, TWO RIVERS, WI 54241 (Tel: 9207932281)

👤

Provider Name / Credentials Updated February 06, 2017

Recorded as ALFREDO DIAZ, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) February 06, 2017

Internal Medicine (License #3310 in NE)

✅

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍

Updated Practice Location July 08, 2007

Registered at 2219 GARFIELD ST, TWO RIVERS, WI 54241 (Tel: 9207932281)

📍

Updated Business Mailing Address July 08, 2007

Registered at 3301 W FOREST HOME AVE, MILWAUKEE, WI 532152843 (Tel: 4146476326)

👤

Provider Name / Credentials Updated July 08, 2007

Recorded as ALFREDO DIAZ, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Internal Medicine (License #39841 in WI)

🟢

Initial NPI Registration & Enumeration August 20, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1902911159

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: August 20, 2006

Last Update: December 01, 2021

Sole Proprietor: No

Update or Correct Profile

Mailing Address

2219 Garfield St

Two Rivers, WI 542412416

Phone: 9207932281

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.