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1421 S Park St Madison WI 53715-2178 | |
| (608) 441-6888 | |
| (608) 441-6888 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1421 S Park St, Madison, Wisconsin |
| Authorized Official Name and Position | Yasmin Yusuf-safavi (MEDICAL DIRECTOR) |
| Authorized Official Contact | 6084439111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1421 S Park St Madison WI 53715-2178 Ph: (608) 441-6888 | 1421 S Park St Madison WI 53715-2178 Ph: (608) 441-6888 |
| NPI Number | 1104127067 |
|---|---|
| Provider Enumeration Date | 11/09/2010 |
| Last Update Date | 03/28/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104127067 | NPI | - | NPPES |
| 1104127067 | Medicaid | WI | |
| 1588705032 | Other | WI | NPI |
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