Provider Demographics
NPI:1083752398
Name:POPLAWSKA GOETZEN, MARIA M (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:M
Last Name:POPLAWSKA GOETZEN
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1905 E. HUEBBE PARKWAY
Mailing Address - Street 2:BELOIT HEALTH SYSTEM INC
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1842
Mailing Address - Country:US
Mailing Address - Phone:608-364-2410
Mailing Address - Fax:608-364-1287
Practice Address - Street 1:1905 E. HUEBBE PARKWAY
Practice Address - Street 2:BELOIT HEALTH SYSTEM INC
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1842
Practice Address - Country:US
Practice Address - Phone:608-364-2410
Practice Address - Fax:608-364-1287
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI48594-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1083752398Medicaid
WI1083752398Medicaid