Provider Demographics
NPI:1528590908
Name:DAVIDSON-FIEDLER, MARLISE K (MD)
Entity Type:Individual
Prefix:
First Name:MARLISE
Middle Name:K
Last Name:DAVIDSON-FIEDLER
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 1:1000 MINERAL POINT AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2940
Mailing Address - Country:US
Mailing Address - Phone:608-756-6611
Mailing Address - Fax:608-756-6177
Practice Address - Street 1:1000 MINERAL POINT AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548
Practice Address - Country:US
Practice Address - Phone:608-756-6611
Practice Address - Fax:608-756-6177
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT9834207Q00000X
WI67824-20208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1528590908OtherBCBSWI
WI1528590908Medicaid
WI1157OtherMERCYCARE INSURANCE
WIK400429384OtherWI MEDICARE