MEDICARE: DR. MARY BETH SEIDLITZ M.D.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0001X	Clinical Cardiac Electrophysiology Physician	30021	MN
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	01062283A	IN
3	207RC0001X	Clinical Cardiac Electrophysiology Physician	2004036077	MO
4	207RC0001X	Clinical Cardiac Electrophysiology Physician	TD061021	ME
5	207RC0000X	Cardiovascular Disease Physician	49894-020	WI
6	207RC0001X	Clinical Cardiac Electrophysiology Physician	49894-020	WI
7	207RI0011X	Interventional Cardiology Physician	49894-020	WI

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

NPI Number	:	1285668731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY BETH SEIDLITZ M.D.

Provider Business Mailing Address
First Line	:	1000 N OAK AVE
Second Line	:
City	:	MARSHFIELD
State	:	WI
Zip	:	54449-5703
Country	:	US
Telephone Number	:	715-387-5511
Fax Number	:

Provider Business Practice Location Address
First Line	:	3501 CRANBERRY BLVD
Second Line	:
City	:	WESTON
State	:	WI
Zip	:	54476-5213
Country	:	US
Telephone Number	:	715-393-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	03/29/2011