Healthcare Provider Details

I. General information

NPI: 1720474513
Provider Name (Legal Business Name): BRITTANY ANNE BUHALOG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY ANNE TRENTADUE

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 N HIGH POINT RD
MADISON WI
53717-2236
US

IV. Provider business mailing address

1808 W BELTLINE HWY
MADISON WI
53713-2334
US

V. Phone/Fax

Practice location:
  • Phone: 608-824-4000
  • Fax: 608-824-4945
Mailing address:
  • Phone: 608-250-1497
  • Fax: 608-250-1384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number5890-851
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number68131
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: