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NPI Code Detail

MEDICARE: ERIC R NIENDORF MD

MEDICARE: ERIC R NIENDORF MD
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
12085B0100XBody Imaging Physician47740MN
22085R0202XDiagnostic Radiology Physician64033WI
32085U0001XDiagnostic Ultrasound Physician47740MN
42085R0202XDiagnostic Radiology Physician47740MN

General Provider Information

NPI Number : 1780685404
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC R NIENDORF MD
Provider Business Mailing Address
First Line : PO BOX 1510
Second Line :
City : EAU CLAIRE
State : WI
Zip : 54702-1510
Country : US
Telephone Number : 715-838-3635
Fax Number :
Provider Business Practice Location Address
First Line : 1400 BELLINGER ST
Second Line :
City : EAU CLAIRE
State : WI
Zip : 54703-5222
Country : US
Telephone Number : 715-883-8522
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2005
Last Update Date : 09/14/2020

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