MEDICARE: BETH E HOTHANZIELINSKI 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
1	208600000X	Surgery Physician	32860	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	49167	OTHER	IA	BLUE CROSS

General Provider Information

NPI Number	:	1982683298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH E HOTHANZIELINSKI MD

Provider Business Mailing Address
First Line	:	2000 S MAIN
Second Line	:
City	:	FAIRFIELD
State	:	IA
Zip	:	52556-9572
Country	:	US
Telephone Number	:	641-469-4204
Fax Number	:	641-469-4208

Provider Business Practice Location Address
First Line	:	2000 S MAIN
Second Line	:
City	:	FAIRFIELD
State	:	IA
Zip	:	52556-9572
Country	:	US
Telephone Number	:	641-469-4204
Fax Number	:	641-469-4208

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

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	05/01/2013

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