Provider Demographics
NPI:1982683298
Name:HOTHANZIELINSKI, BETH E (MD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:E
Last Name:HOTHANZIELINSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:E
Other - Last Name:HOTHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2000 S MAIN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-9572
Mailing Address - Country:US
Mailing Address - Phone:641-469-4204
Mailing Address - Fax:641-469-4208
Practice Address - Street 1:2000 S MAIN
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-9572
Practice Address - Country:US
Practice Address - Phone:641-469-4204
Practice Address - Fax:641-469-4208
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32860208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA49167OtherBLUE CROSS
IA0196659Medicare ID - Type Unspecified
IA49167OtherBLUE CROSS
IAI14726Medicare ID - Type Unspecified