Healthcare Provider Details

I. General information

NPI: 1003318809
Provider Name (Legal Business Name): ORIEL MEDICINE S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 02/04/2021
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5231 UNIVERSITY AVE
MADISON WI
53705-1361
US

IV. Provider business mailing address

5231 UNIVERSITY AVE
MADISON WI
53705-1361
US

V. Phone/Fax

Practice location:
  • Phone: 608-238-0100
  • Fax: 608-238-7550
Mailing address:
  • Phone: 608-238-0100
  • Fax: 608-238-7550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36704
License Number StateWI

VIII. Authorized Official

Name: KATHY ORIEL
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 608-238-0100