Provider Demographics
NPI:1447233259
Name:LUX, BETH A (MD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:A
Last Name:LUX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 S 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-1401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:910 MAIN RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON ISLAND
Practice Address - State:WI
Practice Address - Zip Code:54246-9004
Practice Address - Country:US
Practice Address - Phone:920-847-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25666-020207P00000X
WI25666207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30692100Medicaid
WI30692100Medicaid
WI0006Medicare ID - Type Unspecified