Basic Information
| Provider Information | |||||||||
| NPI: | 1427168582 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELSCH | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 HELEN ST | ||||||||
| Address2: | |||||||||
| City: | SAUK CITY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535831101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6086433351 | ||||||||
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| Practice Location | |||||||||
| Address1: | 112 HELEN ST | ||||||||
| Address2: | |||||||||
| City: | SAUK CITY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535831101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6086433351 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 09/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0000X | 321547 | LA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics | 207V00000X | 39998 | WI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 321547 | 01 | LA | MEDICAL LICENSE | OTHER | 32445600 | 05 | WI | MEDICAID | 1B4705 | 01 | LA | MEDICARE | OTHER |