MEDICARE: KRISTIN FIEDLER PA-C

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	363A00000X	Physician Assistant	8360	WI
2	363AS0400X	Surgical Physician Assistant	50.004742RX	OH
3	363AS0400X	Surgical Physician Assistant	PA14901	TX

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

General Provider Information

NPI Number	:	1205389350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN FIEDLER PA-C

Provider Business Mailing Address
First Line	:	PO BOX 735044
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-5044
Country	:	US
Telephone Number	:	800-326-2250
Fax Number	:	833-437-1275

Provider Business Practice Location Address
First Line	:	2901 W KINNICKINNIC RIVER PKWY STE 316
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-3660
Country	:	US
Telephone Number	:	414-385-2601
Fax Number	:

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

Provider Enumeration Date	:	07/25/2016
Last Update Date	:	01/19/2026

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Directions to “ KRISTIN FIEDLER PA-C” Practice Location

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