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NPI Code Detail

MEDICARE: DEBORAH A IHDE MD

MEDICARE: DEBORAH A IHDE 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
1207R00000XInternal Medicine Physician40156WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053317594
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH A IHDE MD
Provider Business Mailing Address
First Line : 820 E GRANT ST
Second Line :
City : APPLETON
State : WI
Zip : 54911-3483
Country : US
Telephone Number : 920-731-5811
Fax Number : 920-738-6293
Provider Business Practice Location Address
First Line : 2500 E CAPITOL DR
Second Line :
City : APPLETON
State : WI
Zip : 54911-8735
Country : US
Telephone Number : 920-731-5811
Fax Number : 920-738-6293
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2005
Last Update Date : 01/26/2012

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Directions to “ DEBORAH A IHDE MD” Practice Location

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