Healthcare Provider Details

I. General information

NPI: 1053608018
Provider Name (Legal Business Name): STEPHANIE K. BETTS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 EAST CAMPUS MALL UHS PRIMARY CARE
MADISON WI
53715-1365
US

IV. Provider business mailing address

333 EAST CAMPUS MALL UHS PRIMARY CARE
MADISON WI
53715-1365
US

V. Phone/Fax

Practice location:
  • Phone: 608-265-5600
  • Fax: 608-262-0674
Mailing address:
  • Phone: 608-265-5600
  • Fax: 608-262-0674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number67187
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: