Basic Information
| Provider Information | |||||||||
| NPI: | 1801026596 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEIER | ||||||||
| FirstName: | BRENTON | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8003 | ||||||||
| Address2: | |||||||||
| City: | APPLETON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549128003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9208305900 | ||||||||
| FaxNumber: | 9207385787 | ||||||||
| Practice Location | |||||||||
| Address1: | 820 E GRANT ST | ||||||||
| Address2: | |||||||||
| City: | APPLETON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549113483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9208315050 | ||||||||
| FaxNumber: | 9207386400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2009 | ||||||||
| LastUpdateDate: | 05/02/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 106990 | MN | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP2900X | 56999 | MN | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | 56999 | MN | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 55872 | WI | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 208VP0000X | 55872 | WI | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | K400239022 | 01 | WI | MEDICARE PTAN | OTHER | K400239021 | 01 | WI | MEDICARE PTAN | OTHER |