Healthcare Provider Details

I. General information

NPI: 1629038815
Provider Name (Legal Business Name): UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4590 COUNTY RD N
COTTAGE GROVE WI
53527-9208
US

IV. Provider business mailing address

7974 UW HEALTH COURT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-839-3104
  • Fax: 608-839-3404
Mailing address:
  • Phone: 608-829-5270
  • Fax: 608-833-5039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ROBERT FLANNERY
Title or Position: CAO & CFO
Credential:
Phone: 608-821-4223