Mary Patricia Eldridge, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

54685-20 Issued in WI

Practice address

1400 75TH St
Suite #5
Kenosha, WI 53143-1544

Phone

(262) 656-1911

Fax

(888) 316-8458

NPI assigned

Jun 23, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lipid Specialists, S.C.

  • Medical Specialty Clinic/Center
  • Kenosha, WI
  • NPI 1710287628
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442620800000",
    "number": "1063673903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 75TH ST",
            "address_2": "SUITE #5",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531431544",
            "telephone_number": "262-656-1911",
            "fax_number": "888-316-8458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 75TH ST",
            "address_2": "SUITE #5",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531431544",
            "telephone_number": "262-656-1911",
            "fax_number": "888-316-8458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELDRIDGE",
        "first_name": "MARY",
        "middle_name": "PATRICIA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-23",
        "last_updated": "2015-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "WI",
            "license": "54685-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Eide
• Nancy Sue Eisner
• Jeffna Elavumkal, OD
• Nichole M Elcano, DDS
• Eugene John Eldridge, M.D.
• Arneetrice Ellerman, COMS
• Erin Ellsworth, APNP
• Joshua Knute Elson, MD, MPH
• Christopher Aaron Elwell, DPT
• Ember and Oak

• General Practice Physician in Kenosha, WI
• Providers in Kenosha, WI by specialty
• General Practice Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.