Provider Demographics
NPI:1407852593
Name:SEAGREN, ANN R (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:R
Last Name:SEAGREN
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 1:235 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CROIX FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54024-4117
Mailing Address - Country:US
Mailing Address - Phone:715-483-3261
Mailing Address - Fax:715-483-0507
Practice Address - Street 1:235 E STATE ST
Practice Address - Street 2:
Practice Address - City:SAINT CROIX FALLS
Practice Address - State:WI
Practice Address - Zip Code:54024-4117
Practice Address - Country:US
Practice Address - Phone:715-483-3261
Practice Address - Fax:715-483-0507
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34291800Medicaid
WI34291800Medicaid
1032230OtherPREFERRED ONE
49170OtherMEDICARE GROUP
298L4RYOtherBCBSMN
P00149175OtherPALMETTO GBA RR MEDICARE
49170OtherMEDICARE GROUP
WI00496-0040Medicare ID - Type Unspecified