| Integrative Health Center Of Central Wisconsin Llc | |
|
3205 E Washington Ave Ste A Madison WI 53704-4332 | |
| (608) 222-2700 | |
| (608) 222-2771 |
| Full Name | Integrative Health Center Of Central Wisconsin Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3205 E Washington Ave Ste A, Madison, Wisconsin |
| Authorized Official Name and Position | Jonathan Cotter (OWNER) |
| Authorized Official Contact | 6082222700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrative Health Center Of Central Wisconsin Llc 3205 E Washington Ave Ste A Madison WI 53704-4332 Ph: () - | Integrative Health Center Of Central Wisconsin Llc 3205 E Washington Ave Ste A Madison WI 53704-4332 Ph: (608) 222-2700 |
| NPI Number | 1255974952 |
|---|---|
| Provider Enumeration Date | 10/25/2019 |
| Last Update Date | 01/20/2020 |
| Medicare PECOS PAC ID | 4082049382 |
|---|---|
| Medicare Enrollment ID | O20200114003460 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255974952 | NPI | - | NPPES |
| 34668700 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jonathan J Cotter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003989724 PECOS PAC ID: 8628008125 Enrollment ID: I20050815000720 |
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