Healthcare Provider Details

I. General information

NPI: 1265498778
Provider Name (Legal Business Name): DEBASISH BHATTACHARYYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CLAY ST
DARLINGTON WI
53530-1228
US

IV. Provider business mailing address

800 CLAY ST
DARLINGTON WI
53530-1228
US

V. Phone/Fax

Practice location:
  • Phone: 608-776-5748
  • Fax: 608-776-5719
Mailing address:
  • Phone: 608-776-4466
  • Fax: 608-776-5716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35.087860
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036-139526
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number036-139526
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number52689-20
License Number StateWI
# 5
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number52689-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: