Provider Demographics
NPI:1386647246
Name:LANDWEHR, MARY LISA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:LISA
Last Name:LANDWEHR
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Gender:F
Credentials:MD
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Mailing Address - Street 1:2829 COUNTY HIGHWAY I
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-4410
Mailing Address - Country:US
Mailing Address - Phone:715-726-3096
Mailing Address - Fax:715-726-3979
Practice Address - Street 1:2829 COUNTY HIGHWAY I
Practice Address - Street 2:SUITE 2
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-2652
Practice Address - Country:US
Practice Address - Phone:715-726-3096
Practice Address - Fax:715-726-3979
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2011-05-06
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Provider Licenses
StateLicense IDTaxonomies
WI45925207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIH77162OtherGROUP HEALTH
WIH77162OtherMA GROUP HEALTH
WI87843OtherGREATER MARSHFIELD PLAN
WI01-14760OtherMEDICA
WI370T4LAOtherATRIUM SENIOR PLAN
WI34433500OtherWISCONSIN RISK
WI34433500Medicaid
WI391435797OtherEMPLOYERS HEALTH
WI370T4LAOtherATRIUM
WIW005284OtherCHAMPUS
WI2135289OtherFIRST HEALTH
WI370T4LAOtherBLUE CROSS MINNESOTA
WI864421040063OtherPREFERRED ONE
WIP00058497OtherTRAVELERS RAILROAD
WIH77162OtherMA GROUP HEALTH
WI87843OtherGREATER MARSHFIELD PLAN