Organization
SOUTHEAST ANESTHESIOLOGY
Active
Other names
SEAC, SC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES WIDEBURG M.D. (PRESIDENT)
(800) 883-7243
Entity
Organization
Contact information
Practice address
3801 SPRING ST, RACINE, WI 53405-1667
(262) 687-4011
Mailing address
210 N TUSTIN AVE, SANTA ANA, CA 92705-3807
(800) 883-7243
(714) 647-1245
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32836400
—
WI
Enumeration date
06/17/2006
Last updated
06/08/2009
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