Healthcare Provider Details

I. General information

NPI: 1154424489
Provider Name (Legal Business Name): GREGORY TODD RIFLEMAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DRIVE
MINNEAPOLIS MN
55417
US

IV. Provider business mailing address

6611 N 1313TH ST.
PRESCOTT WI
54021-7026
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-4685
  • Fax:
Mailing address:
  • Phone: 715-262-3875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number598
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: