Healthcare Provider Details

I. General information

NPI: 1144648346
Provider Name (Legal Business Name): JUAN SEBASTIAN DANOBEITIA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N HANCOCK ST UNIT 333
MADISON WI
53703-3913
US

IV. Provider business mailing address

311 N HANCOCK ST UNIT 333
MADISON WI
53703-3913
US

V. Phone/Fax

Practice location:
  • Phone: 608-215-9166
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number66070
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number66070
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: