Healthcare Provider Details

I. General information

NPI: 1083916506
Provider Name (Legal Business Name): FREDERICK A ROBERTSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2010
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HIGHLAND AVE
MADISON WI
53792-0001
US

IV. Provider business mailing address

938 WINDING WAY
MIDDLETON WI
53562-5073
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-8100
  • Fax: 608-263-0575
Mailing address:
  • Phone: 608-250-9897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number20246-020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number24246
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: