1386647246 NPI number — DR. MARY LISA LANDWEHR MD

Table of content: DR. MARY LISA LANDWEHR MD (NPI 1386647246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386647246 NPI number — DR. MARY LISA LANDWEHR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANDWEHR
Provider First Name:
MARY
Provider Middle Name:
LISA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386647246
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2829 COUNTY HIGHWAY I
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
CHIPPEWA FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54729-4410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-726-3096
Provider Business Mailing Address Fax Number:
715-726-3979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2829 COUNTY HIGHWAY I
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
CHIPPEWA FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54729-2652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-726-3096
Provider Business Practice Location Address Fax Number:
715-726-3979
Provider Enumeration Date:
05/24/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  45925 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: H77162 . This is a "GROUP HEALTH" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: H77162 . This is a "MA GROUP HEALTH" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 87843 . This is a "GREATER MARSHFIELD PLAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 01-14760 . This is a "MEDICA" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 370T4LA . This is a "ATRIUM SENIOR PLAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 34433500 . This is a "WISCONSIN RISK" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 34433500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 391435797 . This is a "EMPLOYERS HEALTH" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 370T4LA . This is a "ATRIUM" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: W005284 . This is a "CHAMPUS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 2135289 . This is a "FIRST HEALTH" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 370T4LA . This is a "BLUE CROSS MINNESOTA" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 864421040063 . This is a "PREFERRED ONE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: P00058497 . This is a "TRAVELERS RAILROAD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".