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1780681445

NPI Code Detail

MEDICARE: DR. MARK RIEDY MD

MEDICARE: DR. MARK RIEDY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	54662	WI
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	22748	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	CM7718	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	02914	OTHER	NC	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	H503647762	OTHER	SC	H503647762

General Provider Information

NPI Number	:	1780681445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK RIEDY MD

Provider Business Mailing Address
First Line	:	2845 GREENBRIER RD
Second Line	:	SUITE 210
City	:	GREEN BAY
State	:	WI
Zip	:	54311-6519
Country	:	US
Telephone Number	:	920-288-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2845 GREENBRIER RD
Second Line	:	SUITE 210
City	:	GREEN BAY
State	:	WI
Zip	:	54311-6519
Country	:	US
Telephone Number	:	920-288-8100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	02/05/2026

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Directions to “ DR. MARK RIEDY MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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