MEDICARE: LORI MANKOWSKI-GETTLE M.D., M.B.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085B0100X	Body Imaging Physician	63771	WI

General Provider Information

NPI Number	:	1376869594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI MANKOWSKI-GETTLE M.D., M.B.A.

Provider Business Mailing Address
First Line	:	2356 W LAWN AVE
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53711-1954
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2356 W LAWN AVE
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53711-1954
Country	:	US
Telephone Number	:	--
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2010
Last Update Date	:	07/02/2023

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