Basic Information
| Provider Information | |||||||||
| NPI: | 1669400883 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIESSER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7868 BEDROCK FLATS LN E | ||||||||
| Address2: | |||||||||
| City: | BAILEYS HARBOR | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9202179704 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2845 GREENBRIER RD | ||||||||
| Address2: | |||||||||
| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 543116519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9202883388 | ||||||||
| FaxNumber: | 9202883370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 10/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 26659 | WI | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 104082944 | 05 | MI | MEDICAID | 050064020 | 01 | WI | RAILROAD | OTHER | 104390521 | 05 | MI | MEDICAID | 30654000 | 05 | WI | MEDICAID |