Provider Demographics
NPI:1073542221
Name:BELLG, LAURIN A (MD)
Entity Type:Individual
Prefix:
First Name:LAURIN
Middle Name:A
Last Name:BELLG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 E CAPITOL DR
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-8735
Mailing Address - Country:US
Mailing Address - Phone:920-734-9600
Mailing Address - Fax:920-734-4773
Practice Address - Street 1:2500 E CAPITOL DR
Practice Address - Street 2:SUITE 1700
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-8735
Practice Address - Country:US
Practice Address - Phone:920-734-9600
Practice Address - Fax:920-734-4773
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40409020207R00000X
WI40409207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34274400Medicaid
110239820OtherRR MEDICARE
110239820OtherRR MEDICARE
WIH65878Medicare UPIN
WI001045445Medicare Oscar/Certification
110239820OtherRR MEDICARE