Healthcare Provider Details

I. General information

NPI: 1871569392
Provider Name (Legal Business Name): PETER M POPIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CHEQUAMEGON BAY
MADISON WI
53719-3089
US

IV. Provider business mailing address

18 CHEQUAMEGON BAY
MADISON WI
53719-3089
US

V. Phone/Fax

Practice location:
  • Phone: 608-831-3305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25800
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25800
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: