Provider Demographics
NPI:1932126620
Name:FRANTZ, MARY H (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:H
Last Name:FRANTZ
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 1:515 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1569
Mailing Address - Country:US
Mailing Address - Phone:608-324-2000
Mailing Address - Fax:
Practice Address - Street 1:515 22ND AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1569
Practice Address - Country:US
Practice Address - Phone:608-324-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12286207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10863OtherDEAN HEALTH PLAN
1000344OtherPHYSICIANS PLUS
31086900OtherHIRSP
39080850920OtherUNITY
90002361OtherWEA INS
390854503016OtherBC/BS MEDICARE SUPPLEMENT
390854503016OtherBC/BS
390854503016OtherCOMPCARE
70251017OtherILLINOIS PUBLIC AID
WI31086900Medicaid
1000344OtherPHYSICIANS PLUS