Healthcare Provider Details

I. General information

NPI: 1235246190
Provider Name (Legal Business Name): LISA K SEEFELD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA K PESCH MD

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 VALLEY AVE
WEST BEND WI
53095-5312
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-338-1123
  • Fax: 262-338-7142
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number40087
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: