Individual
DR. ELANA FRAN WISTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2825 PRAIRIE AVE, BELOIT, WI 53511-1844
(608) 363-5500
(608) 363-5539
Mailing address
2825 PRAIRIE AVE, BELOIT, WI 53511-1844
(608) 363-5500
(608) 363-5539
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
5101017794
MI
207V00000X
Obstetrics & Gynecology Physician
Primary
57321-21
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1134376486
BCBSWI
WI
05
—
1134376486
—
WI
01
—
WISTRELA
MERCYCARE INSURANCE
WI
Enumeration date
08/19/2008
Last updated
01/21/2013
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