| Miramont Physician Group | |
|
3169 Deming Way Middleton WI 53562-1435 | |
| (608) 716-8288 | |
| Not Available |
| Full Name | Miramont Physician Group |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 3169 Deming Way, Middleton, Wisconsin |
| Authorized Official Name and Position | Paul Gilbert (CHIEF LEGAL OFFICER) |
| Authorized Official Contact | 6157164924 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Miramont Physician Group 3169 Deming Way Middleton WI 53562-1435 Ph: () - | Miramont Physician Group 3169 Deming Way Middleton WI 53562-1435 Ph: (608) 716-8288 |
| NPI Number | 1265189013 |
|---|---|
| Provider Enumeration Date | 03/02/2022 |
| Last Update Date | 09/27/2023 |
| Certification Date | 09/27/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265189013 | NPI | - | NPPES |
| 100192621 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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