Healthcare Provider Details

I. General information

NPI: 1245270446
Provider Name (Legal Business Name): EMILY B PORTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 FISH HATCHERY RD
MADISON WI
53715-1909
US

IV. Provider business mailing address

1211 FISH HATCHERY RD
MADISON WI
53715-1909
US

V. Phone/Fax

Practice location:
  • Phone: 608-824-4000
  • Fax: 608-882-6492
Mailing address:
  • Phone: 608-824-4000
  • Fax: 608-882-6492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number51219-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number51219-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: