Healthcare Provider Details

I. General information

NPI: 1366252942
Provider Name (Legal Business Name): DREW FARRAHAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HIGHLAND AVE
MADISON WI
53792-0001
US

IV. Provider business mailing address

2734 LYNN TER APT 2
MADISON WI
53705-3776
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-6400
  • Fax:
Mailing address:
  • Phone: 847-650-5327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number25039030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: