Healthcare Provider Details

I. General information

NPI: 1336674217
Provider Name (Legal Business Name): MICHAEL PATRICK RIES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S PARK ST
MADISON WI
53715-1507
US

IV. Provider business mailing address

202 S PARK ST
MADISON WI
53715-1507
US

V. Phone/Fax

Practice location:
  • Phone: 608-417-6676
  • Fax: 608-417-5746
Mailing address:
  • Phone: 608-417-6676
  • Fax: 608-417-5746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number69985-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number69985
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: