Provider Demographics
NPI:1124060280
Name:RILLING, RICHARD G (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:RILLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:MAUSTON
Mailing Address - State:WI
Mailing Address - Zip Code:53948-1931
Mailing Address - Country:US
Mailing Address - Phone:608-847-5000
Mailing Address - Fax:
Practice Address - Street 1:225 CHURCH ST
Practice Address - Street 2:DEAN MEDICAL CENTER
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-1801
Practice Address - Country:US
Practice Address - Phone:608-877-2700
Practice Address - Fax:608-877-2728
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34558-020207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI8398OtherDEAN HEALTH INSURANCE
WI32328200Medicaid
G50313Medicare UPIN
WI064174150Medicare PIN
WI32328200Medicaid