Healthcare Provider Details

I. General information

NPI: 1497442537
Provider Name (Legal Business Name): MADELINE CAMILLE DANG MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W CAPITOL DR
GLENDALE WI
53212-1185
US

IV. Provider business mailing address

220 W CAPITOL DR
GLENDALE WI
53212-1185
US

V. Phone/Fax

Practice location:
  • Phone: 414-727-6315
  • Fax:
Mailing address:
  • Phone: 414-727-6320
  • Fax: 414-727-6328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL.0009818
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number87490-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: