Provider Demographics
NPI:1265532303
Name:SEEMUTH, STEPHANIE C (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:C
Last Name:SEEMUTH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 6TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-4815
Mailing Address - Country:US
Mailing Address - Phone:641-423-0711
Mailing Address - Fax:641-423-0713
Practice Address - Street 1:1327 6TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-4815
Practice Address - Country:US
Practice Address - Phone:641-423-0711
Practice Address - Fax:641-423-0713
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1655207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN33615OtherWELLMARK
IA5142547Medicaid
IAI4149Medicare ID - Type UnspecifiedGROUP
IAI8540Medicare ID - Type UnspecifiedINDIVIDUAL
A01262Medicare UPIN