Healthcare Provider Details

I. General information

NPI: 1932199940
Provider Name (Legal Business Name): GREGORY PETERMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 11/17/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N OAK AVE MARSHFIELD CLINIC
MARSHFIELD WI
54449-5703
US

IV. Provider business mailing address

1000 N OAK AVE MARSHFIELD CLINIC
MARSHFIELD WI
54449-5703
US

V. Phone/Fax

Practice location:
  • Phone: 715-349-3555
  • Fax:
Mailing address:
  • Phone: 715-349-3555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number35203
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number6740
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: