Healthcare Provider Details

I. General information

NPI: 1093722498
Provider Name (Legal Business Name): MICHAEL WILLIAM TRIERWEILER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 20TH ST
GOTHENBURG NE
69138-1237
US

IV. Provider business mailing address

910 20TH ST
GOTHENBURG NE
69138-1237
US

V. Phone/Fax

Practice location:
  • Phone: 308-537-3661
  • Fax: 308-537-7310
Mailing address:
  • Phone: 308-537-3661
  • Fax: 308-537-7310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number18908
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: