Provider Demographics
NPI:1588650774
Name:FIFIELD, ELIZABETH ANNE (MD)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:FIFIELD
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 1:10222 74TH STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-6800
Mailing Address - Country:US
Mailing Address - Phone:262-697-9200
Mailing Address - Fax:262-697-9206
Practice Address - Street 1:10222 74TH STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-6800
Practice Address - Country:US
Practice Address - Phone:262-697-9200
Practice Address - Fax:262-697-9206
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46283-020174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34485800Medicaid
WI000332399Medicare ID - Type Unspecified
WI34485800Medicaid