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1500 Highland Ave Business Office Madison WI 53705-2274 | |
| (608) 263-5799 | |
| (608) 253-0529 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 1500 Highland Ave, Madison, Wisconsin |
| Authorized Official Name and Position | Kenneth Mount (ASSOCIATE DEAN) |
| Authorized Official Contact | 6082634938 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1500 Highland Ave Business Office Madison WI 53705-2274 Ph: (608) 263-5799 | 1500 Highland Ave Business Office Madison WI 53705-2274 Ph: (608) 263-5799 |
| NPI Number | 1366613804 |
|---|---|
| Provider Enumeration Date | 03/12/2008 |
| Last Update Date | 12/04/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366613804 | NPI | - | NPPES |
| 41210900 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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