Provider Demographics
NPI:1174517965
Name:LAUDERDALE, BARBARA L (MD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:L
Last Name:LAUDERDALE
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 1:804 E FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2831
Mailing Address - Country:US
Mailing Address - Phone:920-722-6692
Mailing Address - Fax:
Practice Address - Street 1:804 E FOREST AVE
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2831
Practice Address - Country:US
Practice Address - Phone:920-722-6692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27706207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30766900Medicaid
B54471Medicare UPIN
WI015145300Medicare PIN
WI30766900Medicaid